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Characteristics of Recurrent Ischemic Stroke After Embolic Stroke of Undetermined Source: Secondary Analysis of a Randomized Clinical Trial

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dc.contributor.author Veltkamp, Roland C.
dc.contributor.author Pearce, Lesly A.
dc.contributor.author Korompoki, Eleni
dc.contributor.author Sharma, Mukul
dc.contributor.author Kasner, Scott E.
dc.contributor.author Toni, Danilo
dc.contributor.author Ameriso, Sebastián Francisco
dc.contributor.author Mundl, Hardi
dc.contributor.author Tatlisumak, Turgut
dc.contributor.author Hankey, Graeme J.
dc.contributor.author Lindgren, Arne
dc.contributor.author Berkowitz, Scott D.
dc.contributor.author Arauz-Gongora, Antonio
dc.contributor.author Ozturk, Serefnur
dc.contributor.author Muir, Keith W.
dc.contributor.author Chamorro, Ángel
dc.contributor.author Perera, Kanjana S.
dc.contributor.author Shuaib, Ashfaq
dc.contributor.author Rudilosso, Salvatore
dc.contributor.author Shoamanesh, Ashkan
dc.contributor.author Connolly, Stuart J.
dc.contributor.author Hart, Robert G.
dc.date.accessioned 2021-05-14T15:05:28Z
dc.date.available 2021-05-14T15:05:28Z
dc.date.issued 2020-09-01
dc.identifier.citation Veltkamp, R., Pearce, L.A., Korompoki, E., Sharma, M., Kasner, S.E., Toni, D.S., Ameriso, S.F., Mundl, H., Tatlisumak, T., Hankey, G.J., Lindgren, A., Berkowitz, S.D., Arauz, A., Ozturk, S., Muir, K.W., Chamorro, Á., Perera, K.S., Shuaib, A., Rudilosso, S., Shoamanesh, A., Connolly, S.J., Hart, R.G., 2020. Characteristics of Recurrent Ischemic Stroke After Embolic Stroke of Undetermined Source: Secondary Analysis of a Randomized Clinical Trial. JAMA Neurol. https://doi.org/10.1001/jamaneurol.2020.1995. es_ES
dc.identifier.uri https://repositorio.fleni.org.ar/xmlui/handle/123456789/481
dc.identifier.uri https://jamanetwork.com/journals/jamaneurology/fullarticle/2767712
dc.description.abstract Importance: The concept of embolic stroke of undetermined source (ESUS) unifies a subgroup of cryptogenic strokes based on neuroimaging, a defined minimum set of diagnostic tests, and exclusion of certain causes. Despite an annual stroke recurrence rate of 5%, little is known about the etiology underlying recurrent stroke after ESUS. Objective: To identify the stroke subtype of recurrent ischemic strokes after ESUS, to explore the interaction with treatment assignment in each category, and to examine the consistency of cerebral location of qualifying ESUS and recurrent ischemic stroke. Design, setting, and participants: The NAVIGATE-ESUS trial was a randomized clinical trial conducted from December 23, 2014, to October 5, 2017. The trial compared the efficacy and safety of rivaroxaban and aspirin in patients with recent ESUS (n = 7213). Ischemic stroke was validated in 309 of the 7213 patients by adjudicators blinded to treatment assignment and classified by local investigators into the categories ESUS or non-ESUS (ie, cardioembolic, atherosclerotic, lacunar, other determined cause, or insufficient testing). Five patients with recurrent strokes that could not be defined as ischemic or hemorrhagic in absence of neuroimaging or autopsy were excluded. Data for this secondary post hoc analysis were analyzed from March to June 2019. Interventions: Patients were randomly assigned to receive rivaroxaban, 15 mg/d, or aspirin, 100 mg/d. Main outcomes and measures: Association of recurrent ESUS with stroke characteristics. Results: A total of 309 patients (205 men [66%]; mean [SD] age, 68 [10] years) had ischemic stroke identified during the median follow-up of 11 (interquartile range [IQR], 12) months (annualized rate, 4.6%). Diagnostic testing was insufficient for etiological classification in 39 patients (13%). Of 270 classifiable ischemic strokes, 156 (58%) were ESUS and 114 (42%) were non-ESUS (37 [32%] cardioembolic, 26 [23%] atherosclerotic, 35 [31%] lacunar, and 16 [14%] other determined cause). Atrial fibrillation was found in 27 patients (9%) with recurrent ischemic stroke and was associated with higher morbidity (median change in modified Rankin scale score 2 [IQR, 3] vs 0 (IQR, 1]) and mortality (15% vs 1%) than other causes. Risk of recurrence did not differ significantly by subtype between treatment groups. For both the qualifying and recurrent strokes, location of infarct was more often in the left (46% and 54%, respectively) than right hemisphere (40% and 37%, respectively) or brainstem or cerebellum (14% and 9%, respectively). Conclusions and relevance: In this secondary analysis of randomized clinical trial data, most recurrent strokes after ESUS were embolic and of undetermined source. Recurrences associated with atrial fibrillation were a minority but were more often disabling and fatal. More extensive investigation to identify the embolic source is important toward an effective antithrombotic strategy. es_ES
dc.language.iso eng es_ES
dc.publisher American Medical Association es_ES
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Stroke es_ES
dc.subject Accidente Cerebrovascular es_ES
dc.title Characteristics of Recurrent Ischemic Stroke After Embolic Stroke of Undetermined Source: Secondary Analysis of a Randomized Clinical Trial es_ES
dc.type info:eu-repo/semantics/article es_ES
dc.type info:eu-repo/semantics/publishedVersion
dc.description.fil Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.
dc.description.fil Fil: Veltkamp, Roland C. Imperial College London. Division of Brain Sciences; Reino Unido. Alfried Krupp Krankenhaus. Department of Neurology; Alemania.
dc.description.fil Fil: Pearce, Lesly A. Biostatistics Consultant; Canadá.
dc.description.fil Fil: Korompoki, Eleni. Imperial College London. Division of Brain Sciences; Reino Unido. National and Kapodistrian University of Athens. Department of Clinical Therapeutics; Grecia.
dc.description.fil Fil: Sharma, Mukul. McMaster University. Department of Medicine. Population Health Research Institute; Canadá.
dc.description.fil Fil: Kasner, Scott E. University of Pennsylvania. Department of Neurology; Estadosm Unidos.
dc.description.fil Fil: Toni, Danilo. Sapienza University of Rome. Department of Human Neurosciences; Italia.
dc.description.fil Fil: Mundl, Hardi. Bayer AG; Alemania.
dc.description.fil Fil: Tatlisumak, Turgut. Sahlgrenska Academy at University of Gothenburg. Institute of Neurosciences and Physiology. Department of Clinical Neuroscience; Suecia. Sahlgrenska University Hospital. Department of Neurology; Suecia.
dc.description.fil Fil: Hankey, Graeme J. University of Western Australia. Medical School. Faculty of Health and Medical Sciences; Australia.
dc.description.fil Fil: Lindgren, Arne. Lund University. Department of Clinical Sciences and Neurology; Suecia. Skåne University Hospital. Department of Neurology; Suecia.
dc.description.fil Fil: Berkowitz, Scott D. Bayer; Estados Unidos.
dc.description.fil Fil: Arauz-Gongora, Antonio. Instituto Nacional de Neurologia y Neurocirugia Manual Velasco Suarez; México.
dc.description.fil Fil: Ozturk, Serefnur. Selcuk University. Faculty of Medicine. Department of Neurology; Turquía.
dc.description.fil Fil: Muir, Keith W. Queen Elizabeth University Hospital. University of Glasgow. Institute of Neuroscience and Psychology; Reino Unido.
dc.description.fil Fil: Chamorro, Ángel. University of Barcelona. Institute Reçerca Biomèdica August Pi i Sunyer. Hospital Clinic of Barcelona. Department of Neuroscience; España.
dc.description.fil Fil: Perera, Kanjana S. McMaster University. Department of Medicine. Population Health Research Institute; Canadá.
dc.description.fil Fil: Shuaib, Ashfaq. University of Alberta. Department of Medicine; Canadá.
dc.description.fil Fil: Rudilosso, Salvatore. University of Barcelona. Institute Reçerca Biomèdica August Pi i Sunyer. Hospital Clinic of Barcelona. Department of Neuroscience; España.
dc.description.fil Fil: Shoamanesh, Ashkan. McMaster University. Department of Medicine. Population Health Research Institute; Canadá.
dc.description.fil Fil: Connolly, Stuart J. McMaster University. Department of Medicine. Population Health Research Institute; Canadá.
dc.description.fil Fil: Hart, Robert G.. McMaster University. Department of Medicine. Population Health Research Institute; Canadá.
dc.relation.ispartofVOLUME 77
dc.relation.ispartofNUMBER 10
dc.relation.ispartofPAGINATION 1233-1240.
dc.relation.ispartofCOUNTRY Estados Unidos
dc.relation.ispartofCITY Chicago
dc.relation.ispartofTITLE JAMA Neurology
dc.relation.ispartofISSN 2168-6157
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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