Embolic Stroke of Undetermined Source (ESUS): Exploring the Neurocardiological Axis and Its Clinical Implications
Embolic stroke of undetermined source (ESUS) was proposed in 2014 as a clinical category to subgroup non-lacunar cryptogenic ischemic strokes that appear embolic but lack an identifiable cause despite thorough investigation. The initial hypothesis was that anticoagulation might offer superior second...
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MDPI AG
2025-07-01
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| Online Access: | https://www.mdpi.com/1648-9144/61/7/1252 |
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| author | Gabriela Dumachita Sargu Roxana Covali Cristiana Filip Tudor Butureanu Mona Akad Ioana Păvăleanu Andrei Ionuț Cucu Amelian Mădălin Bobu Laura Riscanu Diana Lacatusu Madalina Irina Smihor Radu Popa |
| author_facet | Gabriela Dumachita Sargu Roxana Covali Cristiana Filip Tudor Butureanu Mona Akad Ioana Păvăleanu Andrei Ionuț Cucu Amelian Mădălin Bobu Laura Riscanu Diana Lacatusu Madalina Irina Smihor Radu Popa |
| author_sort | Gabriela Dumachita Sargu |
| collection | DOAJ |
| description | Embolic stroke of undetermined source (ESUS) was proposed in 2014 as a clinical category to subgroup non-lacunar cryptogenic ischemic strokes that appear embolic but lack an identifiable cause despite thorough investigation. The initial hypothesis was that anticoagulation might offer superior secondary prevention compared to antiplatelet therapy, prompting several large clinical trials. This review synthesizes current knowledge on ESUS. ESUS represents about 17% of ischemic strokes and often affects younger patients with fewer traditional risk factors. Although these patients lack major cardioembolic sources (e.g., atrial fibrillation) or significant arterial stenosis, many have covert embolic substrates. Major trials—NAVIGATE ESUS, RE-SPECT ESUS, and the atrial cardiopathy-focused ARCADIA—found no benefit of anticoagulants over aspirin, challenging the original ESUS framework. These results highlight the heterogeneity within ESUS and underscore the need for individualized diagnostic and therapeutic strategies. |
| format | Article |
| id | doaj-art-9eeed9a38f2e4551be1ecffc6e59136c |
| institution | Matheson Library |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-9eeed9a38f2e4551be1ecffc6e59136c2025-07-25T13:29:32ZengMDPI AGMedicina1010-660X1648-91442025-07-01617125210.3390/medicina61071252Embolic Stroke of Undetermined Source (ESUS): Exploring the Neurocardiological Axis and Its Clinical ImplicationsGabriela Dumachita Sargu0Roxana Covali1Cristiana Filip2Tudor Butureanu3Mona Akad4Ioana Păvăleanu5Andrei Ionuț Cucu6Amelian Mădălin Bobu7Laura Riscanu8Diana Lacatusu9Madalina Irina Smihor10Radu Popa11Department of Obstetrics and Gynecology, Elena Doamna Obstetrics and Gynecology University Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaDepartment of Radiology, Elena Doamna Obstetrics and Gynecology University Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaDepartment of Biochemistry, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaDepartment of Obstetrics and Gynecology, Elena Doamna Obstetrics and Gynecology University Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaDepartment of Obstetrics and Gynecology, Elena Doamna Obstetrics and Gynecology University Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaDepartment of Obstetrics and Gynecology, Elena Doamna Obstetrics and Gynecology University Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaFaculty of Medicine and Biological Sciences, University Stefan cel Mare of Suceava, 720229 Suceava, RomaniaDepartment of Cardiology, Sf. Spiridon Hospital, 700111 Iași, RomaniaDepartment of Morphophunctional Sciences, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaDepartment of Pharmacological Physics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaDepartment of Neurology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaDepartment of Vascular Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, RomaniaEmbolic stroke of undetermined source (ESUS) was proposed in 2014 as a clinical category to subgroup non-lacunar cryptogenic ischemic strokes that appear embolic but lack an identifiable cause despite thorough investigation. The initial hypothesis was that anticoagulation might offer superior secondary prevention compared to antiplatelet therapy, prompting several large clinical trials. This review synthesizes current knowledge on ESUS. ESUS represents about 17% of ischemic strokes and often affects younger patients with fewer traditional risk factors. Although these patients lack major cardioembolic sources (e.g., atrial fibrillation) or significant arterial stenosis, many have covert embolic substrates. Major trials—NAVIGATE ESUS, RE-SPECT ESUS, and the atrial cardiopathy-focused ARCADIA—found no benefit of anticoagulants over aspirin, challenging the original ESUS framework. These results highlight the heterogeneity within ESUS and underscore the need for individualized diagnostic and therapeutic strategies.https://www.mdpi.com/1648-9144/61/7/1252embolic stroke of undetermined sourcecryptogenic strokeTOAST classificationsecondary stroke preventionatrial fibrillationpatent foramen ovale |
| spellingShingle | Gabriela Dumachita Sargu Roxana Covali Cristiana Filip Tudor Butureanu Mona Akad Ioana Păvăleanu Andrei Ionuț Cucu Amelian Mădălin Bobu Laura Riscanu Diana Lacatusu Madalina Irina Smihor Radu Popa Embolic Stroke of Undetermined Source (ESUS): Exploring the Neurocardiological Axis and Its Clinical Implications Medicina embolic stroke of undetermined source cryptogenic stroke TOAST classification secondary stroke prevention atrial fibrillation patent foramen ovale |
| title | Embolic Stroke of Undetermined Source (ESUS): Exploring the Neurocardiological Axis and Its Clinical Implications |
| title_full | Embolic Stroke of Undetermined Source (ESUS): Exploring the Neurocardiological Axis and Its Clinical Implications |
| title_fullStr | Embolic Stroke of Undetermined Source (ESUS): Exploring the Neurocardiological Axis and Its Clinical Implications |
| title_full_unstemmed | Embolic Stroke of Undetermined Source (ESUS): Exploring the Neurocardiological Axis and Its Clinical Implications |
| title_short | Embolic Stroke of Undetermined Source (ESUS): Exploring the Neurocardiological Axis and Its Clinical Implications |
| title_sort | embolic stroke of undetermined source esus exploring the neurocardiological axis and its clinical implications |
| topic | embolic stroke of undetermined source cryptogenic stroke TOAST classification secondary stroke prevention atrial fibrillation patent foramen ovale |
| url | https://www.mdpi.com/1648-9144/61/7/1252 |
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