並列摘要
Embolic stroke of undetermined source (ESUS) is an embolic subtype of cryptogenic stroke requiring a minimum diagnostic assessment to exclude those with incomplete assessments or other stroke etiologies. The diagnostic definition of ESUS includes (1) non-lacunar infarction, (2) no ＞ 50% severe atherosclerotic stenosis in large arteries supplying the ischemic area, (3) no major-risk cardioembolic sources, and (4) no other specific causes of stroke. Potential embolic sources of ESUS include minor-risk cardiac sources, paradoxical embolism from veins, and non-occlusive (＜50%) atherosclerotic plaques in the aortic arch or cervical cerebral arteries. The frequencies of ESUS range from 9 to 25% (average 17%) of ischemic stroke and patient characteristics include mild symptoms but high recurrent rates. Hence, the identification and preventive strategies of ESUS are important. The risk of stroke recurrence and death in ESUS patients can be stratified and predicted using CHA2DS2-VASc scores. Although antiplatelets are recommended for secondary prevention of ESUS, optimal treatments, including antiplatelets, anticoagulants or nonpharmacological interventional therapies, are based on elucidation of most possible pathophysiologies, i.e. turning ESUS into ESPS (embolic stroke of possible source).
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