Results of specialized outpatient follow-up of patients with embolic stroke of undetermined source
https://doi.org/10.24884/1607-4181-2021-28-1-23-31
Abstract
Background. The article considers with the current problem of cryptogenic stroke and embolic stroke of undetermined source.
The objective was to analyzed the results of follow-up of patients with embolic stroke of undetermined source in a specialized outpatient center.
Methods and materials. The data of 169 patients who completed a two-year follow-up period with embolic stroke of undetermined source (ESUS) and cardioembolic stroke were analyzed.
Results. We presented comparative results on the structure of incidence rate, age differences, comorbid pathology, as well as on the frequency of repeated cardiovascular events in groups with cardioembolic stroke and embolic stroke of undetermined source.
Conclusions. Patients with ESUS are an extremely difficult category of patients for diagnostic search, for whom the actual task is to develop an examination algorithm for the earliest possible detection of the cause of stroke and to determine the optimal methods of secondary prevention.
About the Authors
P. I. Merkureva
City consultative and diagnostic center № 1
Russian Federation
Competing Interests:
Russian Federation
Merkureva Polina I. - Neurologist of the Stroke Prevention Center, City consultative and diagnostic center № 1.
10, Sikeyrosa str., Saint Petersburg, 194354.
Competing Interests:
Authors declare no conflict of interest.
J. D. Bogatenkova
City consultative and diagnostic center № 1
Russian Federation
Competing Interests:
Russian Federation
Bogatenkova Julia D. - Cand. of Sci. (Med.), Head of the Stroke Prevention Center, City consultative and diagnostic center № 1.
10, Sikeyrosa str., Saint Petersburg, 194354.
Competing Interests:
Authors declare no conflict of interest.
I. A. Voznyuk
Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine
Russian Federation
Competing Interests:
Russian Federation
Voznyuk Igor A. - Dr. of Sci. (Med.), Professor, Deputy Director for Scientific Work, Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, Chief Freelance Neurologist.
Saint Petersburg.
Competing Interests:
Authors declare no conflict of interest.
V. A. Sorokoumov
Pavlov University
Russian Federation
Competing Interests:
Russian Federation
Sorokoumov Victor А. - Dr. of Sci. (Med.), Professor of the Department of Neurology, Pavlov University.
Saint Petersburg.
Competing Interests:
Authors declare no conflict of interest.
E. A. Popov
City consultative and diagnostic center № 1
Russian Federation
Competing Interests:
Russian Federation
Popov Evgeny A. = Cand. of Sci. (Med.), Chief Physician, City consultative and diagnostic center № 1.
10, Sikeyrosa str., Saint Petersburg, 194354.
Competing Interests:
Authors declare no conflict of interest.
References
1. Hart R. G., Diener H. C., Coutts S. B. et al. Embolic strokes of undetermined source: the case for a new clinical construct // Lancet Neurol. 2014;13(4):429-438. Doi: 10.1016/S1474-4422(13)70310-7.
2. Nouh A., Hussain M., Mehta T., Yaghi S. Embolic Strokes of Unknown Source and Cryptogenic Stroke: Implications in Clinical Practice // Front Neurol. 2016;(7):37. Doi: 10.3389/fneur.2016.00037.
3. Saver J. L. Cryptogenic Stroke // N Engl J Med. 2016; 374(21):2065J. 2074. Doi: 10.1056/NEJMcp1503946.
4. Liebeskind A., Chinichian A., Schechter M. M. The moving embolus seed during serial cerebral angiography // Stroke. 1971;2(5):440-443. Doi: 10.1161/01.STR.2.5.440.
5. Kulesh A. A., Drobakha V. E., Shestakov V. V. Cryptogenic stroke // Neurology, neuropsychiatry, psychosomatics. 2019;11(4):14-21. Doi: 10.144112/2074-2711-2019-4-14-21.
6. Ryoo S., Chung J. W., Lee M. J. et al. An Approach to Working Up Cases of Embolic Stroke of Undetermined Source // J. Am. Heart Assoc. 2016 ;5(3):e002975. Doi: 10.1161/JAHA.115.002975.
7. Yaghi S., Bernstein R. A., Passman R., Okin P. M. Cryptogenic Stroke: Research and Practice // Circ. Res. 2017;120(3):527-540. Doi: 10.1161/CIRCRESAHA.116.308447.
8. Shamalov N. A., Kustova M. A. Cryptogenic stroke // Neurology, neuropsychiatry, psychosomatics. 2014;6(2S): 42-49. Doi:10.14412/2074-2711-2014-2S-42-49.
9. Ntaios G., Papavasileiou V., Milionis H., Makaritsis K., Vemmou A., Koroboki E. et al. Embolic strokes of undetermined source in the Athens stroke registry: an outcome analysis // Stroke. 2015;46(8):2087-2093. Doi: 10.1161/STROKEAHA.115.009334.
10. Li L., Yiin G. S., Geraghty O. C. et al. Oxford Vascular Study. Incidence, outcome, risk fac- tors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study // Lancet Neurol. 2015; 14(9):903-913. Doi: 10.1016/S1474-4422(15)00132-5.
11. Bang O. Y., Ovbiagele B., Kim J. S. Evaluation of cryptogenic stroke with advanced diagnostic techniques // Stroke. 2014;45(4):1186-1194. Doi: 10.1161/STROKEAHA.113.003720.
12. Kalashnikova L. A., Dobrynina L. A. Ischemic stroke at a young age // Journal of neurology and psychiatry. 2017;(8). Is. 2.
13. Perera K. S., Swaminathan B., Veltkamp R. et al. Frequency and features of embolic stroke of undetermined source in young adults // Eur. Stroke Journal. 2018;3(2):110-116. Doi: 10.1177/2396987318755585.
14. Alsheikh-Ali A. A., Thaler D. E., Kent D. M. Patent foramen ovale in cryptogenic stroke: incidental or pathogenic? // Stroke. 2009;40(7):2349-2355. Doi: 10.1161/STROKEAHA.109.547828.
15. Kong Q., Ma X. Contributing Mechanisms of Aortic Atheroma in Ischemic Cerebrovascular Disease // J. Stroke Cerebrovasc. Dis. 2015;24(12):2653-2659. Doi: 10.1016/j.jstrokecerebrovasdis.2015.09.033.
16. Zavala J. A., Amarrenco P., Davis S. M. et al. Aortic arch atheroma // Int J Stroke. 2006. 1(2):74J-80. Doi: 10.1111/j.1747-4949.2006.00026.x.
17. Bang O. Y., Lee P. H., Joo S. Y., Lee J. S., Joo I. S., Huh K. Frequency and mechanisms of stroke recurrence after cryptogenic stroke // Ann Neurol. 2003; 4 (2):227-234. Doi: 10.1002/ana.1064. PMID: 12891675.
18. Ntaios G., Papavasileiou V., Milionis H., Makaritsis K., Vemmou A., Koroboki E., Manios E., Spengos K., Michel P., Vemmos K. Embolic Strokes of Undetermined Source in the Athens Stroke Registry: An Outcome Analysis // Stroke. 2015;(46):2087-2093. Doi: 10.1161/STROKEAHA.115.009334.
19. Hankey G. J., Jamrozik K., Broadhurst R. et al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study // Stroke. 2000;(31):2080-2086. Doi: 10.1161/01.str.31.9.2080.
20. Kistler J. P. The risk of embolic stroke. Another piece of the puzzle // N Engl J Med. 1994;331(22):1517-1519. Doi: 10.1056/NEJM199412013312211.
21. Mohr J. P., Thompson J. L. P., Lazar R. M. et al. Warfarin-Aspirin Recurrent Stroke Study Group. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke // New Engl J Med. 2001;345(20):1444-1451. Doi: 10.1056/NEJMoa011258.
22. Sacco R. L., Prabhakaran S., Thompson J. L. P et al. WARSS Investigators. Comparison of warfarin versus aspirin for the prevention of recurrent stroke or death: subgroup analyses from the Warfarin-Aspirin Recurrent Stroke Study // Cerebrovasc Dis. 2006;22(1):4-12. Doi: 10.1159/000092331.
23. Hart R. G., Sharma M., Mundl H. et al. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source // N Engl J Med. 2018;378(23):2191-2201. Doi: 10.1056/NEJMoa1802686.
24. Hans-Christoph Diener, Ralph L. Sacco, J. Donald Easton et al. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source // N Engl J Med 2019;(380):1906-1917. Doi: 10.1056/NEJMoa1813959
Review
For citations:
Merkureva P.I., Bogatenkova J.D., Voznyuk I.A., Sorokoumov V.A., Popov E.A. Results of specialized outpatient follow-up of patients with embolic stroke of undetermined source. The Scientific Notes of the Pavlov University. 2021;28(1):23-31. (In Russ.) https://doi.org/10.24884/1607-4181-2021-28-1-23-31
Views:
415
Email this article 