从 CHALLENGE ESUS/CS 登记的启示看来源不明的栓塞性中风的概述和未来方向。

IF 3 2区 医学 Q2 PERIPHERAL VASCULAR DISEASE Journal of atherosclerosis and thrombosis Pub Date : 2024-09-27 DOI:10.5551/jat.RV22026
Muneaki Kikuno, Yuji Ueno
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引用次数: 0

摘要

隐源性卒中(CS)约占急性缺血性卒中的四分之一,大多数病例来自栓塞性病因。2014 年,来源不明的栓塞性卒中(ESUS)得到提倡,抗凝疗法的疗效也被寄予厚望。然而,3 项大规模临床试验未能证明直接口服抗凝药(DOACs)优于阿司匹林,这可能是由于 ESUS 的病因异质多样,包括阵发性心房颤动(AF)、动脉源(如非狭窄性颈动脉斑块和主动脉复杂病变(ACL))、卵圆孔未闭(PFO)以及与活动性癌症相关的非细菌性血栓性心内膜炎(NBTE)。经食道超声心动图(TEE)是评估 ESUS 和 CS 中栓塞源的最有效成像方式之一。经食管超声心动图明确来源不明的栓塞性卒中/隐源性卒中的机制(CHALLENGE ESUS/CS)登记是一项多中心登记,登记了2014年4月至2016年12月期间在日本8家医院接受TEE检查的连续CS患者。他们的平均年龄为 68.7±12.8 岁,455 名患者(67.2%)为男性。美国国立卫生研究院卒中量表(NIHSS)的中位数评分为 2 分。由于迄今为止每个机构已进行了 7 次分析,因此该多中心注册研究对 ESUS 和 CS 的栓塞起源和病理生理学有了新的重要见解。本综述将讨论 ESUS 和 CS 的诊断和治疗,追溯其过去和未来的发展方向。此外,还参考并分析了 CHALLENGE ESUS/CS 登记中的重要见解。
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Overview and Future Direction of Embolic Stroke of Undetermined Source from the Insights of CHALLENGE ESUS/CS Registry.

Cryptogenic stroke (CS) accounts for approximately one-fourth of acute ischemic strokes, with most cases derived from embolic etiologies. In 2014, embolic stroke of undetermined source (ESUS) was advocated and the efficacy of anticoagulant therapy was anticipated. However, 3 large-scale clinical trials failed to demonstrate the superiority of direct oral anticoagulants (DOACs) over aspirin, potentially due to the heterogeneous and diverse pathologies of ESUS, including paroxysmal atrial fibrillation (AF), arteriogenic sources such as nonstenotic carotid plaque and aortic complicated lesion (ACL), patent foramen oval (PFO), and nonbacterial thrombotic endocarditis (NBTE) related to active cancer.Transesophageal echocardiography (TEE) is one of the most effective imaging modalities for assessing embolic sources in ESUS and CS. The Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for Embolic Stroke of Undetermined Source/Cryptogenic Stroke (CHALLENGE ESUS/CS) registry is a multicenter registry that enrolled consecutive patients with CS who underwent TEE at 8 hospitals in Japan between April 2014 and December 2016. Their mean age was 68.7±12.8 years, and 455 patients (67.2%) were male. The median National Institutes of Health Stroke Scale (NIHSS) score was 2. Since 7 analyses have been conducted from each institution to date, novel and significant insights regarding embolic origins and pathophysiologies of ESUS and CS were elucidated from this multicenter registry. This review discusses the diagnosis and treatment of ESUS and CS, tracing their past and future directions. Meaningful insights from the CHALLENGE ESUS/CS registry are also referenced and analyzed.

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来源期刊
CiteScore
6.60
自引率
15.90%
发文量
271
审稿时长
1 months
期刊介绍: JAT publishes articles focused on all aspects of research on atherosclerosis, vascular biology, thrombosis, lipid and metabolism.
期刊最新文献
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