Skip to main content
Journal cover image

Embolic strokes of undetermined source: the case for a new clinical construct.

Publication ,  Journal Article
Hart, RG; Diener, H-C; Coutts, SB; Easton, JD; Granger, CB; O'Donnell, MJ; Sacco, RL; Connolly, SJ ...
Published in: Lancet Neurol
April 2014

Cryptogenic (of unknown cause) ischaemic strokes are now thought to comprise about 25% of all ischaemic strokes. Advances in imaging techniques and improved understanding of stroke pathophysiology have prompted a reassessment of cryptogenic stroke. There is persuasive evidence that most cryptogenic strokes are thromboembolic. The thrombus is thought to originate from any of several well established potential embolic sources, including minor-risk or covert cardiac sources, veins via paradoxical embolism, and non-occlusive atherosclerotic plaques in the aortic arch, cervical, or cerebral arteries. Accordingly, we propose that embolic strokes of undetermined source are a therapeutically relevant entity, which are defined as a non-lacunar brain infarct without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation. Because emboli consist mainly of thrombus, anticoagulants are likely to reduce recurrent brain ischaemia more effectively than are antiplatelet drugs. Randomised trials testing direct-acting oral anticoagulants for secondary prevention of embolic strokes of undetermined source are warranted.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Lancet Neurol

DOI

EISSN

1474-4465

Publication Date

April 2014

Volume

13

Issue

4

Start / End Page

429 / 438

Location

England

Related Subject Headings

  • Thromboembolism
  • Stroke
  • Neurology & Neurosurgery
  • Humans
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hart, R. G., Diener, H.-C., Coutts, S. B., Easton, J. D., Granger, C. B., O’Donnell, M. J., … Cryptogenic Stroke/ESUS International Working Group, . (2014). Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol, 13(4), 429–438. https://doi.org/10.1016/S1474-4422(13)70310-7
Hart, Robert G., Hans-Christoph Diener, Shelagh B. Coutts, J Donald Easton, Christopher B. Granger, Martin J. O’Donnell, Ralph L. Sacco, Stuart J. Connolly, and Stuart J. Cryptogenic Stroke/ESUS International Working Group. “Embolic strokes of undetermined source: the case for a new clinical construct.Lancet Neurol 13, no. 4 (April 2014): 429–38. https://doi.org/10.1016/S1474-4422(13)70310-7.
Hart RG, Diener H-C, Coutts SB, Easton JD, Granger CB, O’Donnell MJ, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014 Apr;13(4):429–38.
Hart, Robert G., et al. “Embolic strokes of undetermined source: the case for a new clinical construct.Lancet Neurol, vol. 13, no. 4, Apr. 2014, pp. 429–38. Pubmed, doi:10.1016/S1474-4422(13)70310-7.
Hart RG, Diener H-C, Coutts SB, Easton JD, Granger CB, O’Donnell MJ, Sacco RL, Connolly SJ, Cryptogenic Stroke/ESUS International Working Group. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014 Apr;13(4):429–438.
Journal cover image

Published In

Lancet Neurol

DOI

EISSN

1474-4465

Publication Date

April 2014

Volume

13

Issue

4

Start / End Page

429 / 438

Location

England

Related Subject Headings

  • Thromboembolism
  • Stroke
  • Neurology & Neurosurgery
  • Humans
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences