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Updated: Sep 22, 2025

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

From cryptogenic to ESUS: Toward precision medicine?

¹Université Brest, Inserm, EFS, UMR 1078, GGB, 29200 Brest, France; Neurology and Stroke unit Department, CHRU de Brest, Inserm1078, Université de Bretagne Occidentale, 29200 Brest, France.

Revue Neurologique

|May 21, 2022

Summary

This summary is machine-generated.

Embolic stroke of undetermined source (ESUS) requires refined classification beyond current definitions. Identifying specific subgroups like patent foramen ovale (PFO) or atrial fibrillation (AF) is crucial for precision medicine in stroke prevention.

Keywords:

ASCOD Cryptogenic Stroke ESUS Patent Foramen Ovale Population-based registry SSS-TOAST TOAST atrial cardiomyopathy carotid web covert atrial fibrillation precision medicine;

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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

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Area of Science:

Neurology
Cardiology
Vascular Medicine

Background:

Cryptogenic infarctions lack a defined cause despite thorough investigation.
Embolic stroke of undetermined source (ESUS) is a refinement, focusing on specific work-ups for non-lacunar brain infarcts.
Potential ESUS sources include patent foramen ovale (PFO), covert atrial fibrillation (AF), and atheroma.

Purpose of the Study:

To refine the classification of embolic stroke of undetermined source (ESUS).
To identify homogeneous patient subgroups within ESUS for targeted therapies.
To advance precision medicine in stroke prevention by stratifying patient risk.

Main Methods:

Review of existing definitions and studies on cryptogenic stroke and ESUS.
Analysis of potential embolic sources in ESUS patients, including PFO, AF, and atheroma.
Proposal for a new ESUS classification into subgroups based on identified causes.

Main Results:

Patent foramen ovale (PFO) occlusion is superior to medical treatment for recurrent stroke in patients under 60.
Randomized trials of direct oral anticoagulants (DOAs) in ESUS showed no difference compared to aspirin, highlighting patient heterogeneity.
Current ESUS classification does not adequately identify homogeneous groups for targeted treatment.

Conclusions:

The ESUS classification needs further refinement to identify specific patient subgroups.
Proposed subgroups include ESUS-PFO>60, ESUS-ATH, ESUS-AF, and ESUS-cancer.
Stratifying ESUS patients into homogeneous groups is essential for future therapeutic trials and precision medicine in stroke prevention.