Stroke: Patients with embolic stroke of undetermined origin, frequency and pattern of cerebral infarction

Originally proposed in 2014, embolic strokes of undetermined origin (ESUS) represent a large subgroup of cryptogenic strokes (assuming embolic mechanisms), which include non-lacunar ischemic strokes without a major source of cardiac embolism Stroke (nonlacunar ischemic strokes with no major cardiac source of embolism), and no related arterial stenosis
.

It is estimated that, ESUS cent of all ischemic cerebral stroke 20-30%, affecting relatively young stroke patients, the main cause mild, not disabling stroke
.
No one has previously described in detail the number and patterns of cerebral infarctions detected by magnetic resonance imaging (MRI) in ESUS patients recently

In NAVIGATE (ESUS New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source) in MIND NMR, the research-initiated NMR is the use of designated acquisitions in a subgroup of trial participants Standards, and centralized assessment by people who do not know the clinical characteristics or treatment allocation
.

In this way, Mukul Sharma and others of the Population Health Research Institute in Canada, the core purpose of the research is to determine the range of cerebral infarction in patients with ESUS in the near future
.

They, in the NAVIGATE ESUS trial, conducted an MRI sub-study at 87 locations in 15 countries

Among the 918 sub-study cohort participants, the average age was 67 years, 60% were men, and the median (interquartile range) between eligible ischemic stroke and MRI was 64 (26-115) days
.

On MRI, 855 people (93%) had recent or chronic cerebral infarction, of which 646 (70%) were multiple and 62% (401/646) involved multiple arterial areas
.

Among eligible ESUS people who had no history of stroke or transient ischemic attack before, 68% (510/755) had multiple cerebral infarctions
.
The previous stroke/transient ischemic attack (P<0.
001), the modified Rankin scale score>0 (P<0.

From the distribution point of view, 89% (757/855) of infarct patients have large and/or cortical infarctions, while 11% (98/855) of infarct patients have only small and subcortical infarctions
.

Among those patients with multiple large and/or cortical infarctions, 57% (251/437) had one or more involved vascular areas different from those of eligible ESUS

The important significance of this study lies in the discovery that most ESUS patients, including those who have not had a clinical stroke or transient ischemic attack before, have multiple large-area and/or cortical cerebral infarctions detected by MRI, reflecting clinical stroke And the huge burden of recessive cerebral infarction
.
Infarcts most often involve multiple vascular areas

Original source:
Sharma M, Smith EE, Pearce LA, et al.
Frequency and Patterns of Brain Infarction in Patients With Embolic Stroke of Undetermined Source: NAVIGATE ESUS Trial.
Stroke.
Published online September 20, 2021.