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Age-related burden and characteristics of embolic stroke of undetermined source in the real world clinical practice

  • Elisa Grifoni
  • Davide Giglio
  • Giulia Guazzini
  • Eleonora Cosentino
  • Ester Latini
  • Alessandro Dei
  • Attilio Del Rosso
  • Vincenzo Guarnaccia
  • Mariella Baldini
  • Maria Letizia Bartolozzi
  • Pietro Martinucci
  • Francesca Sani
  • Antonio Giordano
  • Francesca Dainelli
  • Francesca Maggi
  • Chiara Giulietti
  • Mario Romagnoli
  • Stefano Cinotti
  • Elena Schipani
  • Giuseppe Salvatore Murgida
  • Stefania Di Martino
  • Andrea Cozzi
  • Adele Carli Ballola
  • Debora Dacomo
  • Debora Valori
  • Luca MasottiEmail author
Article

Abstract

Few data are available on age-related burden and characteristics of embolic stroke of undetermined source (ESUS) in the real world clinical practice. The aim of our study was to provide information about it. We retrospectively analyzed data of patients consecutively admitted to our Stroke Unit along 1 year (2017, November 1st–2018, October 31st). The etiology of ischemic stroke was defined at hospital discharge; ESUS was considered as a subset of cryptogenic stroke, and defined according to the 2014 international criteria. In the analyzed period, 306 patients, 52.3% females, mean age ± SD 77.9 ± 11.9 years, were discharged with diagnosis of ischemic stroke. Ischemic strokes of cardioembolic and lacunar origin were the most frequent subtypes: 30.1% and 29.4%, respectively. Cardioembolic strokes were particularly frequent in patients ≥ 75 years, and almost always associated with atrial fibrillation. Overall, in 80 patients (26.1%) the etiology of stroke was undetermined; in 25 (8.2%) it remained undefined because of death or severe comorbidity, making further diagnostic work-up not worthy. Cryptogenic stroke occurred in 55 patients (18%), and ESUS criteria were satisfied in 39 of them (12.7%). According to age, cryptogenic stroke was diagnosed in 21.1% (21.1% ESUS) of patients < 65 years, 24.2% (19.4% ESUS) of patients aged 65–74 years, 15.5% (9.2% ESUS) of patients ≥ 75 years. After diagnostic work-up, patent foramen ovale was most commonly associated with ESUS (17.9%), especially in patients < 65 years (62.5%); covert paroxysmal atrial fibrillation was detected in 10.5% of ESUS patients ≥ 75 years. In the real world clinical practice, the frequency of ischemic strokes of undetermined etiology, and of those satisfying ESUS criteria, is not negligible, especially in younger patients. A thorough diagnostic work-up, with an age-specific approach, is therefore necessary and of the utmost importance for the identification of stroke etiology, in order to optimize secondary stroke prevention strategies.

Keywords

Ischemic stroke etiology Cryptogenic stroke Embolic stroke of undetermined source (ESUS) Atrial fibrillation Patent foramen ovale 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Elisa Grifoni
    • 1
  • Davide Giglio
    • 1
  • Giulia Guazzini
    • 1
  • Eleonora Cosentino
    • 1
  • Ester Latini
    • 1
  • Alessandro Dei
    • 1
  • Attilio Del Rosso
    • 2
  • Vincenzo Guarnaccia
    • 2
  • Mariella Baldini
    • 3
  • Maria Letizia Bartolozzi
    • 3
  • Pietro Martinucci
    • 4
  • Francesca Sani
    • 4
  • Antonio Giordano
    • 1
  • Francesca Dainelli
    • 1
  • Francesca Maggi
    • 1
  • Chiara Giulietti
    • 1
  • Mario Romagnoli
    • 1
  • Stefano Cinotti
    • 1
  • Elena Schipani
    • 1
  • Giuseppe Salvatore Murgida
    • 1
  • Stefania Di Martino
    • 1
  • Andrea Cozzi
    • 1
  • Adele Carli Ballola
    • 1
  • Debora Dacomo
    • 1
  • Debora Valori
    • 2
  • Luca Masotti
    • 1
    Email author
  1. 1.Internal Medicine II and Stroke UnitSan Giuseppe HospitalEmpoliItaly
  2. 2.CardiologySan Giuseppe HospitalEmpoliItaly
  3. 3.NeurologySan Giuseppe HospitalEmpoliItaly
  4. 4.CardiologySan Giovanni di Dio HospitalFlorenceItaly

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