Department of Neurology, Tokyo Women's Medical University.
J Atheroscler Thromb. 2022 Mar 1;29(3):393-402. doi: 10.5551/jat.61895. Epub 2021 Feb 18.
This study aimed at clarifying the incidence of recurrent stroke and its etiology in patients with embolic stroke of undetermined source (ESUS) and other stroke subtypes in both the acute and chronic periods.
A total of 645 patients who were admitted with acute ischemic stroke (IS) between March 2015 and August 2019 were enrolled. Among them, 511 patients with ESUS, cardioembolism (CE), large artery atherosclerosis (LAA), or small vessel disease (SVD) were analyzed in this study. After discharge, 391 patients who visited the outpatient clinic were followed up until August 2020. The outcome was stroke recurrence.
In the acute admission, recurrence rates were 7.6%, 8.1%, 18.8%, and 2.2% in patients with ESUS, CE, LAA, and SVD, respectively, and there were significant differences between the groups. The subtype of recurrence was almost identical to that of the index stroke. In the outpatient clinic, the annual recurrence rates were 4.4%, 4.3%, 6.0%, and 2.9% in ESUS, CE, LAA, and SVD, respectively, and no difference was observed. Subtypes of recurrence in outpatients with ESUS included ESUS, intracerebral hemorrhage (ICH), and SVD. Patients with ESUS and SVD had a higher risk of ICH during follow-up.
Although the risk of recurrence was comparable between patients with ESUS and CE and intermediate between patients with LAA and SVD, in the acute admission unit, the risk in outpatients was similar among all subtypes. ESUS was the most recurrent stroke subtype in outpatients with ESUS. The risk of hemorrhagic stroke was significant in patients with SVD and ESUS.
本研究旨在阐明不明来源栓塞性卒中（ESUS）和其他卒中亚型患者在急性期和慢性期内复发性卒中的发生率及其病因。
共纳入 2015 年 3 月至 2019 年 8 月期间因急性缺血性卒中（IS）入院的 645 例患者。其中，511 例 ESUS、心源性栓塞（CE）、大动脉粥样硬化（LAA）或小血管疾病（SVD）患者纳入本研究。出院后，391 例门诊就诊患者随访至 2020 年 8 月。结局为卒中复发。
在急性期，ESUS、CE、LAA 和 SVD 患者的复发率分别为 7.6%、8.1%、18.8%和 2.2%，组间差异有统计学意义。复发性卒中亚型与指数性卒中几乎一致。在门诊期间，ESUS、CE、LAA 和 SVD 患者的年复发率分别为 4.4%、4.3%、6.0%和 2.9%，差异无统计学意义。ESUS 门诊患者的复发性卒中亚型包括 ESUS、脑出血（ICH）和 SVD。ESUS 和 SVD 患者在随访期间ICH 风险较高。
尽管 ESUS 患者与 CE 患者的复发风险相当，且介于 LAA 患者与 SVD 患者之间，但在急性期住院患者中，所有亚型的门诊患者的复发风险相似。在 ESUS 门诊患者中，ESUS 是最常见的复发性卒中亚型。SVD 和 ESUS 患者的出血性卒中风险显著。
