Hart Robert G, Catanese Luciana, Perera Kanjana S, Ntaios George, Connolly Stuart J
From the Department of Medicine (Neurology) (R.G.H., L.C., K.S.P.), Population Health Research Institute and Department of Medicine (Cardiology) (S.J.C.), McMaster University, Hamilton Health Sciences, Ontario, Canada; Department of Medicine, Larissa University Hospital, University of Thessaly, Larissa, Greece (G.N.).
Stroke. 2017 Apr;48(4):867-872. doi: 10.1161/STROKEAHA.116.016414. Epub 2017 Mar 6.
Embolic stroke of undetermined source (ESUS) designates patients with nonlacunar cryptogenic ischemic strokes in whom embolism is the likely stroke mechanism. It has been hypothesized that anticoagulation is more efficacious than antiplatelet therapy for secondary stroke prevention in ESUS patients. We review available information about ESUS.
Systematic literature review to assess the frequency of ESUS, patient features, and prognosis using PubMed from 2014 to present, unrestricted by language.
On the basis of 9 studies, the reported frequency of ESUS ranged from 9% to 25% of ischemic strokes, averaging 17%. From 8 studies involving 2045 ESUS patients, the mean age was 65 years and 42% were women; the mean NIH stroke score was 5 at stroke onset (4 studies, 1772 ESUS patients). Most (86%) ESUS patients were treated with antiplatelet therapy during follow-up, with the annualized recurrent stroke rate averaging 4.5% per year during a mean follow-up of 2.7 years (5 studies, 1605 ESUS patients).
ESUS comprises about 1 ischemic stroke in 6. Patients with ischemic stroke meeting criteria for ESUS were relatively young compared with other ischemic stroke subtypes and had, on average, minor strokes, consistent with small emboli. Retrospective methods of available studies limit confidence in stroke recurrence rates but support a substantial (>4% per year) rate of stroke recurrence during (mostly) antiplatelet therapy. There is an important need to define better antithrombotic prophylaxis for this frequently occurring subtype of ischemic stroke.
不明来源栓塞性卒中（ESUS）指非腔隙性隐源性缺血性卒中患者，其卒中机制可能为栓塞。有假说认为，对于ESUS患者的二级卒中预防，抗凝治疗比抗血小板治疗更有效。我们回顾了有关ESUS的现有信息。
通过系统文献回顾，使用2014年至今的PubMed评估ESUS的发生率、患者特征和预后，不受语言限制。
基于9项研究，报告的ESUS发生率在缺血性卒中的9%至25%之间，平均为17%。在涉及2045例ESUS患者的8项研究中，平均年龄为65岁，42%为女性；卒中发作时的平均美国国立卫生研究院卒中量表（NIHSS）评分为5分（4项研究，1772例ESUS患者）。大多数（86%）ESUS患者在随访期间接受抗血小板治疗，在平均2.7年的随访期间，年化复发性卒中率平均为每年4.5%（5项研究，1605例ESUS患者）。
ESUS约占每6例缺血性卒中中的1例。与其他缺血性卒中亚型相比，符合ESUS标准的缺血性卒中患者相对年轻，平均为轻度卒中（小栓子所致）。现有研究的回顾性方法限制了对卒中复发率的可信度，但支持在（主要为）抗血小板治疗期间有较高的（每年>4%）卒中复发率。对于这种常见的缺血性卒中亚型，迫切需要更好地确定抗栓预防措施。
