Risk of recurrent ischemic stroke in young cryptogenic patients with embolic stroke of undetermined source

Abstract

In young patients, cause of ischemic stroke (IS) remains very often cryptogenic and thus effectiveness of secondary prevention may be uncertain. Elderly cryptogenic IS patients (CIS) with ESUS (Embolic Stroke of Undetermined Source) have a higher risk of recurrent IS (RIS). The aim was to compare risk of RIS between ESUS and other young CIS patients. The study set consisted of young acute IS patients < 50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). In all patients, brain ischemia was confirmed on CT/MRI. Admission ECG, serum specific cardiac and thrombophilia markers, neurosonology, TEE, 24-hour and 3-week ECG-Holter were performed to assess cause of IS according to the ASCOD classification. Of 279 enrolled patients < 50 years (153 males, mean age 41.1 ± 7.8 years), 199 (71%) were identified as cryptogenic and 106 (59 males, mean age 40.7 ± 7.5 years) fulfilled ESUS criteria. During the follow-up with a median of 17 months, two (2%) ESUS and 4 (4%) other CIS patients suffered from RIS (p=0.421). The mean time to RIS did not differ between both groups (14 vs. 27 months, p=0.248). One-year risk of RIS was 0 for ESUS and 0.025 (95% CI: 0-0.059) for other CIS patients (p=0.248). Conclusion: The risk of RIS was very low and did not differ between young ESUS and other CIS patients. Supported by the grant of Ministry of Health of Czech Republic n. 17-30101A and IGA LF UP_008_2019.