Embolic Strokes of Undetermined Source: Key Points
American College of Cardiology
MAY 6, 2024
The following are key points to remember from a European consensus statement on embolic strokes of undetermined source.
Embolism Stroke Strokes 
Artificial intelligence predicts undiagnosed atrial fibrillation in patients with embolic stroke of undetermined source using sinus rhythm electrocardiograms
HeartRhythm
MARCH 14, 2024
Artificial intelligence (AI)-enabled sinus rhythm (SR) electrocardiogram (ECG) interpretation can aid in identifying undiagnosed paroxysmal atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS).
PO-04-049 PATIENTS WITH EMBOLIC STROKE OF UNDETERMINED SOURCE MORE LIKELY TO DEVELOP ATRIAL FIBRILLATION COMPARED WITH OTHER CAUSES OF EMBOLIC STROKE
HeartRhythm
APRIL 30, 2024
AF detection rates with implantable cardiac monitoring (ICM) following cryptogenic stroke are >12% at 12 months. Similar results have been reported in some non-cryptogenic stroke cohorts. Real-world data has also shown a much lower rate of AF detection.
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Predictors of atrial fibrillation detection in embolic stroke of undetermined source patients with implantable loop recorder
Frontiers in Cardiovascular Medicine
MARCH 3, 2024
Background Covert atrial fibrillation (AF) is a predominant aetiology of embolic stroke of undetermined source (ESUS). Evidence suggested that AF is more frequently detected by implantable loop recorder (ILR) than by conventional monitoring.
Retrograde cerebral embolism and pulmonary embolism caused by patent ductus arteriosus: a case report
Journal of Cardiothoracic Surgery
JUNE 26, 2024
Although rare, paradoxical embolism sometimes occurs with patent ductus arteriosus (PDA). This study presents a case of PDA-associated paradoxical embolism with acute ischemic stroke (AIS) and pulmonary emboli.
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Stroke PROTECTion With SEntinel During Transcatheter Aortic Valve Replacement
American College of Cardiology
OCTOBER 29, 2024
The goal of the PROTECTED TAVR trial was to evaluate the efficacy of intraprocedural cerebral embolic protection (CEP) in reducing strokes among patients undergoing transfemoral TAVR for aortic stenosis.
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Optimal timing of oral anticoagulation initiation in patients with acute ischaemic stroke and atrial fibrillation: a comprehensive meta-analysis and systematic review
Open Heart
NOVEMBER 27, 2024
The optimal timing for initiating direct oral anticoagulants (DOACs) for secondary stroke prevention in patients with atrial fibrillation and acute ischaemic stroke remains controversial due to concerns about haemorrhagic transformation. This study aimed to analyse the efficacy and safety of early versus late DOAC initiation.
PO-02-173 IMPACT OF ATRIAL FIBRILLATION DETECTED BY CARDIAC IMPLANTABLE ELECTRONIC DEVICES ON EMBOLIC STROKE EVENTS IN CANCER PATIENTS
HeartRhythm
APRIL 30, 2024
The association between AF detected by implanted cardiac implantable electronic devices (CIEDs) and the incidence of embolic stroke has been reported. Moreover, the cut-off value of new-onset AF duration detected by CIEDs for embolic stroke is still unknown.
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Stroke reduction by cerebral embolic protection devices in transcatheter aortic valve implantation: a systematic review and Bayesian meta-analysis
Heart BMJ
MAY 10, 2024
Objectives The use of cerebral embolic protection (CEP) during transcatheter aortic valve implantation (TAVI) has been studied in several randomised trials. We aimed to perform a systematic review and Bayesian meta-analysis of randomised CEP trials, focusing on a clinically relevant reduction in disabling stroke.
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52 PO-04-089 ATRIAL MECHANICAL REMODELING COULD BE PREDICTABLE FOR NEWLY DEVELOPED ATRIAL FIBRILLATION IN PATIENTS WITH EMBOLIC STROKE WITH UNDETERMINED SOURCE
HeartRhythm
APRIL 30, 2024
Atrial fibrillation (AF) has been known as a main cause of embolic stroke. Well-chosen candidate to be anticoagulated should be critical for secondary prevention in patients with embolic stroke with undetermined source (ESUS).
Abstract 4141940: Outcomes in Middle Eastern Atrial Fibrillation Patients with Prior Ischemic Stroke/Systemic Embolism: Findings from the JoFib Study
Circulation
NOVEMBER 11, 2024
Patients with a history of prior hemorrhagic stroke were excluded from this analysis. Circulation, Volume 150, Issue Suppl_1 , Page A4141940-A4141940, November 12, 2024.
Abstract TP259: Slower Early Mitral Inflow Velocity and Lesion in Anterior Circulation is Associated With Right-to-Left Shunt in Embolic Stroke of Undetermined Source Right-to-Left Shunt in Embolic Stroke of Undetermined Source
Stroke Journal
FEBRUARY 1, 2024
Stroke, Volume 55, Issue Suppl_1 , Page ATP259-ATP259, February 1, 2024. Background and Purpose:Right-to-left shunt (RLS) is one of the potential embolic sources in embolic stroke of undetermined source (ESUS), but the eligibility of conducting shunt study to detect RLS in ESUS is still unknown. cm/s, p = 0.021).
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Abstract 4140882: Peak Stroke Incidence Following Left Atrial Appendage Closure
Circulation
NOVEMBER 11, 2024
A fib is a well-established risk factor for ischemic strokes. In patients with nonvalvular A fib, the majority of embolic strokes are caused by thrombi development in the left atrial appendage. Systemic anticoagulation (AC) is effective in reducing stroke risk in patients with A fib. 5,661 underwent percutaneous closure.
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Abstract TP223: Predicting Atrial Fibrillation in Embolic Stroke of Unknown Source
Stroke Journal
FEBRUARY 1, 2024
Stroke, Volume 55, Issue Suppl_1 , Page ATP223-ATP223, February 1, 2024. Background:A considerable portion of patients with embolic stroke of unknown source(ESUS)are later found to have occult atrial fibrillation (AF).
Abstract 42: Validation of a New Plaque-RADS Classification System to a Cohort of Embolic Stroke of Undetermined Source Patients
Stroke Journal
FEBRUARY 1, 2024
Stroke, Volume 55, Issue Suppl_1 , Page A42-A42, February 1, 2024. Introduction:A new Plaque-RADS classification (I-IV) is proposed to categorize the degree of carotid plaque instability and risk of embolic ischemic stroke. Carotid total plaque thickness and ulceration were scored by a neuroradiologist blinded to stroke side.
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Evidence and Mechanisms for Embolic Stroke in Contralateral Hemispheres From Carotid Artery Sources
Journal of the American Heart Association
NOVEMBER 28, 2023
BackgroundDisambiguation of embolus pathogenesis in embolic strokes is often a clinical challenge. One common source of embolic stroke is the carotid arteries, with emboli originating due to plaque buildup or perioperatively during revascularization procedures.
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Aspiration of thrombus for intermediate-risk subacute pulmonary embolism
Journal of Cardiothoracic Surgery
APRIL 7, 2024
Pulmonary embolism is the most common cardiovascular disease after myocardial infarction and stroke. Konstantinides (Eur Heart J 41(4):543–603, 2020) Current guidelines categorize patients with PE as being at.
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HonorHealth Research Institute First in Southwest to Implant New Stroke Prevention Stent
DAIC
JUNE 4, 2024
The Neuroguard Integrated Embolic Protection (IEP) system is an experimental treatment for carotid artery stenosis, also known as carotid artery disease, a condition in which fatty-waxy deposits known as plaque builds up and blocks the normal flow of blood in the large arteries on either side of the neck.
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Transcatheter PFO closure for cryptogenic stroke: current approaches and future considerations
Frontiers in Cardiovascular Medicine
MAY 19, 2024
Although generally considered a benign anatomic variant, a PFO may facilitate passage of a thrombus from the venous to arterial circulation, thereby resulting in cryptogenic stroke or systemic embolization.
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Mass screening for atrial fibrillation does not prevent stroke in older adults, research finds
Medical Xpress - Cardiology
SEPTEMBER 3, 2024
Mass screening for atrial fibrillation using ECG together with heart failure biomarker does not prevent ischemic stroke or systemic embolism (blood clot) in older adults aged 75–76 years over 5 years follow-up, according to late breaking research presented in a Hot Line Session at this year's ESC Congress 2024 in London, UK (30 Aug–2 Sept).
Preoperative management and anticoagulant efficacy in atrial myxoma-associated acute ischemic stroke: a case report and literature review
Frontiers in Cardiovascular Medicine
NOVEMBER 12, 2024
Acute ischemic stroke (AIS) is a common complication of atrial myxoma (AM), and most emboli originate from a thrombus attached to the surface of the myxoma, with occasional shedding of tumor fragments leading to stroke. Clinical manifestations of AM include mitral valve obstruction, systemic embolism, and weakness.
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Drug therapies for stroke prevention
The British Journal of Cardiology
NOVEMBER 29, 2023
Stroke is a major cause of mortality, morbidity and economic burden. Strokes can be thrombotic, embolic or haemorrhagic. The key risk factor for cardioembolic stroke is atrial fibrillation or flutter, and oral anticoagulation (OAC) is recommended in all but the lowest-risk patients with evidence of these arrhythmias.
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ARCADIA Trial on Atrial Cardiopathy and Stroke
All About Cardiovascular System and Disorders
FEBRUARY 19, 2024
In an earlier post on Embolic Stroke of Undetermined Source (ESUS) , I had mentioned about ARCADIA trial (AtRial Cardiopathy and Antithrombotic Drugs In Prevention After Cryptogenic Stroke) which was testing whether there is role for apixaban compared to aspirin for prevention of recurrent stroke in ESUS. 2023.27188.
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Abstract 4146431: Acute Brain Attack: Peering Through The Esophageal Window In Cryptogenic Ischemic Stroke
Circulation
NOVEMBER 11, 2024
While intracardiac cardiac tumors and shunts are infrequent and typically asymptomatic, their existence can precipitate severe outcomes, including stroke, myocardial infarction and sudden death.Case Description:A 69-year-old female presented with left sided facial droop, slurred speech and left arm weakness.
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Brain-Protected TAVR Results in Fewer Real-World Disabling Strokes
Med Page Today
JUNE 5, 2024
(MedPage Today) -- NEW YORK CITY -- Researchers eked out evidence of a small clinical benefit with the Sentinel cerebral embolic protection (CEP) device in transcatheter aortic valve replacement (TAVR) -- and pointed to the patients more likely.
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Novel electrocardiographic classification for stroke prediction in atrial fibrillation patients undergoing cardioversion
HeartRhythm
APRIL 24, 2024
Abnormal conduction, structure and function of the atrial myocardium predispose to atrial fibrillation (AF) and stroke. Usefulness of electrocardiographic (ECG) indices in predicting stroke or systemic embolism (SSE) in patients undergoing cardioversion for AF remains unknown, especially in those at low estimated risk.
Link Between Clonal Hematopoiesis and Stroke in Carotid Stenosis
All About Cardiovascular System and Disorders
MAY 22, 2024
About a fifth of all ischemic strokes are attributed to embolization of ruptured atherosclerotic plaque from carotid arterial stenosis. But it has been difficult to predict which person with asymptomatic carotid artery stenosis is likely to progress to symptomatic carotid disease and stroke.
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The efficacy of different types of cerebral embolic protection device during transcatheter aortic valve implantation: a meta-analysis
Frontiers in Cardiovascular Medicine
FEBRUARY 22, 2024
Aims Perioperative stroke remains a devastating complication after transcatheter aortic valve implantation (TAVI), and using a cerebral embolic protection device (CEPD) during TAVI may reduce the occurrence of stroke according to some studies. The risk of stroke was lower in the CEPD group: RR 0.68, 95% CI 0.49–0.96,
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64 PO-04-052 A POLYGENIC RISK SCORE PREDICTS FUTURE ATRIAL FIBRILLATION-RELATED STROKE/SYSTEMIC EMBOLISM
HeartRhythm
APRIL 30, 2024
Polygenic risk score (PRS) might be useful in predicting atrial fibrillation (AF)-related stroke/systemic embolsim (SSE) before diagnosis of clinical AF.
Abstract 4146286: Embolization of an Amplatzer Amulet Through a MitraClip Causing Torsades and LVOT Obstruction: A Case Report
Circulation
NOVEMBER 11, 2024
Left atrial appendage occlusion (LAAO) devices have become increasingly utilized for stroke prevention in select patients with AF who have contraindications to oral anticoagulation (OAC). This case highlights the need for heightened post-procedure monitoring, surveillance, and imaging in select patients.
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Schizophrenia and Types of Stroke: A Mendelian Randomization Study
Journal of the American Heart Association
FEBRUARY 29, 2024
BackgroundPrevious studies suggest an association between schizophrenia and stroke, but no studies have investigated stroke subtypes. Little evidence of associations with the other stroke subtypes was found. Journal of the American Heart Association, Ahead of Print.
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Stroke Prevention in Atrial Fibrillation: Our Current Failures and Required Research
Stroke Journal
DECEMBER 21, 2023
Stroke, Volume 55, Issue 1 , Page 214-225, January 1, 2024. Nonvalvular atrial fibrillation is a common rhythm disorder of middle-aged to older adults that can cause ischemic strokes and systemic embolism.
The ABC?Stroke Risk Score and Effects of Atrial Fibrillation Screening on Stroke Prevention: Results From the Randomized LOOP Study
Journal of the American Heart Association
FEBRUARY 14, 2024
BackgroundThe ABC‐stroke score is a risk scheme for prediction of stroke or systemic embolism (SE) in atrial fibrillation (AF). Having an annual ABC‐stroke risk >1% was associated with stroke/SE, stroke/SE/cardiovascular death, and all‐cause death (hazard ratio, 1.82 [95% CI, 1.44–2.21],
Abstract 4145271: Systemic Lupus Erythematosus-Induced Libman-Sacks Endocarditis Complicated by Multiple Embolic Episodes and Atypical Secondary Valve Involvement
Circulation
NOVEMBER 11, 2024
Acute stroke workup was negative, and syncope was attributed to possible brief seizure. Stroke workup revealed an acute ischemic stroke with total left M2 occlusion of her MCA, and she underwent thrombectomy. Circulation, Volume 150, Issue Suppl_1 , Page A4145271-A4145271, November 12, 2024.
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40 Abstract 64: Biomarkers of Atrial Cardiopathy and Outcomes After Cryptogenic Stroke: The ARCADIA Trial
Stroke Journal
FEBRUARY 1, 2024
Stroke, Volume 55, Issue Suppl_1 , Page A64-A64, February 1, 2024. Background:Atrial cardiopathy is associated with incident ischemic stroke in the absence of clinical atrial fibrillation in prospective cohorts. Recurrent stroke occurred in 80 patients (annualized rate, 4.4%) and death in 54 patients. female, 21.1% Black, and 8.1%
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Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation
The New England Journal of Medicine
NOVEMBER 11, 2023
In a randomized trial involving patients with subclinical (typically asymptomatic) atrial fibrillation, apixaban led to a lower risk of stroke or systemic embolism than aspirin but a higher risk of major bleeding.
Clinical Outcomes of Percutaneous Transcatheter Release of Stuck Mechanical Mitral Valve With Cerebral Embolic Protection
Circulation: Cardiovascular Interventions
JUNE 10, 2024
We reported the feasibility and short-term outcomes of percutaneous transcatheter therapy with cerebral embolic protection. During the follow-up, 12.50% (n=3) all-cause death, 4.17% (n=1) stroke, and 16.67% (n=4) recurrence were seen. 1273.47) days, stroke was 1211.38 (95% CI, 1110.40–1312.35)
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Abstract 97: Acute Ischemic Stroke Despite Anticoagulant Use: The Neuro-AFib Study
Stroke Journal
FEBRUARY 1, 2024
Stroke, Volume 55, Issue Suppl_1 , Page A97-A97, February 1, 2024. vs 19.6%, p=0.002) and a past-history of stroke/TIA (36% vs 25%, p<0.001) when compared to non-AC group. Chronic embolic (non-lacunar) infarcts on imaging were more common among AIS-despite-AC (34.5% Patients who had AIS-despite-AC were younger (76.8+11
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40 Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Review of Established and Emerging Embolic Agents
Stroke: Vascular and Interventional Neurology
AUGUST 24, 2023
Stroke: Vascular and Interventional Neurology, Ahead of Print. Middle meningeal artery embolization is an increasingly common procedure involved in the treatment of chronic subdural hematoma (cSDH) that can be an adjuvant intervention or an alternative to traditional medical or surgical therapies.
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40 PO-03-081 LEFT ATRIAL FUNCTION AND POLYGENIC RISK SCORES FOR PREDICTING ATRIAL FIBRILLATION AND RELATED STROKE/SYSTEMIC EMBOLISM
HeartRhythm
APRIL 30, 2024
Clinical, imaging, and genetic markers in combinations might be useful for risk assessment of atrial fibrillation (AF) and related stroke/systemic embolsim (SSE).
Abstract WP214: Embolization in Chronic Subdural Hematomas
Stroke Journal
FEBRUARY 1, 2024
Stroke, Volume 55, Issue Suppl_1 , Page AWP214-AWP214, February 1, 2024. Introduction:Middle meningeal artery embolization for chronic subdural hematomas is a promising treatment either as an adjuvant to surgical evacuation of the hematoma or as a primary treatment modality. The mean maximal diameter of the collection was 16.3 ± 6.6
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Abstract 4140574: Echoes of Danger: A Case of Recurrent Atrial Myxoma with Cerebral Embolization
Circulation
NOVEMBER 11, 2024
Introduction:Atrial myxomas are cardiac tumors that can cause arterio-occlusive diseases due to embolization of myxomatous fragments. Brain MRI showed bilateral cortical and subcortical MCA ischemic strokes. Circulation, Volume 150, Issue Suppl_1 , Page A4140574-A4140574, November 12, 2024.
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