ReviewTherapeutic advances in neurological disorders2019
Embolic strokes of undetermined source: theoretical construct or useful clinical tool?
Review in Therapeutic advances in neurological disorders, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 34 citations in OpenAlex.
- Cryptogenic stroke in women: impact of insertable cardiac monitoring in the STROKEWISE cohort study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Clinical Significance of Microembolic Signal Detection in Acute Ischemic Stroke: Insights Into Ongoing Cerebral Embolization and Occult Etiologies.European journal of neurology · 2026Article
- Lipoprotein(a) as a Stroke Biomarker: Pathophysiological Pathways and Therapeutic Implications.Journal of clinical medicine · 2025Review
- Prevalence, diagnosis and management of intracranial atherosclerosis in White populations: a narrative review.Neurological research and practice · 2024Review
- The role of non-stenosing carotid artery plaques in embolic stroke of undetermined source, is it a silent offender? A review of literature.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2024Review
- Atrial Fibrillation After Patent Foramen Ovale Closure: Incidence, Pathophysiology, and Management.Journal of the American Heart Association · 2024Review
- Long-term outcomes of patients with embolic stroke of undetermined source according to subtype.Scientific reports · 2024Article
- Prognostic value of central blood pressure on the outcomes of embolic stroke of undetermined source.Scientific reports · 2023Article
- Advances in Noninvasive Carotid Wall Imaging with Ultrasound: A Narrative Review.Journal of clinical medicine · 2022Review
- ESC Working Group on e-Cardiology Position Paper: accuracy and reliability of electrocardiogram monitoring in the detection of atrial fibrillation in cryptogenic stroke patientsEuropean heart journal. Digital health · 2022Review
- European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin.European stroke journal · 2022Article
- Cryptogenic Stroke and Embolic Stroke of Undetermined Source: Risk Factors and Approaches for Detection of Atrial Fibrillation.Current cardiology reviews · 2022Review
- Burden of oral anticoagulation in embolic stroke of undetermined source without atrial fibrillation.BMC cardiovascular disorders · 2021Article
- Non-stenotic Carotid Plaques in Embolic Stroke of Unknown Source.Frontiers in neurology · 2021Review
- Ultrasound Assessment of Extracranial Carotids and Vertebral Arteries in Acute Cerebral Ischemia.Medicina (Kaunas, Lithuania) · 2020Review
- Left Heart Factors in Embolic Stroke of Undetermined Source in a Multiethnic Asian and North African Cohort.Journal of the American Heart Association · 2020Article
- It's Time to Say Goodbye to the ESUS Construct.Frontiers in neurology · 2020Article
- Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke.Stroke research and treatment · 2020Article
- Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke.Journal of clinical medicine · 2019Article
- N-Terminal Pro B-Type Natriuretic Peptide's Usefulness for Paroxysmal Atrial Fibrillation Detection Among Populations Carrying Cardiovascular Risk Factors.Frontiers in neurology · 2019Article
Corrections and comments
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Authors and funding
11 authors at 9 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In 2014, the definition of embolic strokes of undetermined source (ESUS) emerged as a new clinical construct to characterize cryptogenic stroke (CS) patients with complete vascular workup to determine nonlacunar, nonatherosclerotic strokes of presumable embolic origin. NAVIGATE ESUS, the first phase III randomized-controlled, clinical trial (RCT) comparing rivaroxaban (15 mg daily) with aspirin (100 mg daily), was prematurely terminated for lack of efficacy after enrollment of 7213 patients. Except for the lack of efficacy in the primary outcome, rivaroxaban was associated with increased risk of major bleeding and hemorrhagic stroke compared with aspirin. RE-SPECT ESUS was the second phase III RCT that compared the efficacy and safety of dabigatran (110 or 150 mg, twice daily) to aspirin (100 mg daily). The results of this trial have been recently presented and showed similar efficacy and safety outcomes between dabigatran and aspirin. Indirect analyses of these trials suggest similar efficacy on the risk of ischemic stroke (IS) prevention, but higher intracranial hemorrhage risk in ESUS patients receiving rivaroxaban compared to those receiving dabigatran (indirect HR = 6.63, 95% CI: 1.38-31.76). ESUS constitute a heterogeneous group of patients with embolic cerebral infarction. Occult AF represents the underlying mechanism of cerebral ischemia in the minority of ESUS patients. Other embolic mechanisms (paradoxical embolism via patent foramen ovale, aortic plaque, nonstenosing unstable carotid plaque, etc.) may represent alternative mechanisms of cerebral embolism in ESUS, and may mandate different management than oral anticoagulation. The potential clinical utility of ESUS may be challenged since the concept failed to identify patients who would benefit from anticoagulation therapy. Compared with the former diagnosis of CS, ESUS patients required thorough investigations; more comprehensive diagnostic work-up than is requested in current ESUS diagnostic criteria may assist clinicians in uncovering the source of brain embolism in CS patients and individualize treatment approaches.
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