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Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
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[Embolic Stroke of Undetermined Source].

Teruyuki Hirano1

  • 1Department of Stroke and Cerebrovascular Medicine, Kyorin University Faculty of Medicine.

Brain and Nerve = Shinkei Kenkyu No Shinpo
|June 10, 2017
PubMed
Summary

Embolic stroke of undetermined source (ESUS) is a distinct condition potentially benefiting from anticoagulation, particularly direct oral anticoagulants (DOACs). Ongoing trials are investigating DOACs for secondary prevention in ESUS patients.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Embolic stroke of undetermined source (ESUS) is a clinical construct for non-lacunar strokes without clear causes.
  • Diagnosis relies on excluding other stroke etiologies, leading to a heterogeneous patient group.
  • Current guidelines often recommend antiplatelets, but anticoagulation may be more appropriate for ESUS.

Purpose of the Study:

  • To define ESUS as a therapeutically relevant entity.
  • To explore potential embolic sources in ESUS, including covert atrial fibrillation and aortic plaque.
  • To highlight the potential benefit of anticoagulation, especially DOACs, for secondary stroke prevention in ESUS.

Main Methods:

  • Definition of ESUS based on exclusion criteria: non-lacunar infarction, absence of proximal arterial stenosis (>50%), and no cardioembolic sources.

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  • Identification of potential embolic sources: covert atrial fibrillation, low-risk cardiac sources, aortic plaque, cancer-associated embolism, and paradoxical embolism.
  • Review of current treatment guidelines and ongoing randomized trials for ESUS.

    • Main Results:

    • ESUS represents a significant proportion of ischemic strokes where the embolic source remains undetermined.
    • The heterogeneity of ESUS suggests diverse underlying pathologies requiring tailored treatment.
    • Anticoagulation, specifically with DOACs, is being investigated as a potentially superior treatment over antiplatelets for secondary prevention.

    Conclusions:

    • ESUS is a clinically relevant diagnosis that warrants further investigation into optimal secondary prevention strategies.
    • The potential for anticoagulation in ESUS, particularly DOACs, offers a promising therapeutic avenue.
    • Ongoing randomized trials are crucial for establishing evidence-based recommendations for DOAC use in ESUS.