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Der Klinikarzt 2019; 48(03): 78-81
DOI: 10.1055/a-0861-8564
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© Georg Thieme Verlag Stuttgart · New York

Embolischer Schlaganfall unbekannter Quelle (ESUS)

Hat sich das Konzept bewährt?
Ulf Ziemann
1   Abteilung Neurologie mit Schwerpunkt neurovaskuläre Erkrankungen, und Hertie-Institut für Klinische Hirnforschung, Eberhard-Karls-Universität Tübingen, Tübingen
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Publication History

Publication Date:
01 April 2019 (online)

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ZUSAMMENFASSUNG

ESUS (embolischer Schlaganfall unbekannter Quelle) wurde als pathogenetisches Konzept mit der Erwartung entwickelt, dass eine orale Antikoagulation wirksamer als eine Thrombozytenfunktionshemmung einen erneuten Schlaganfall verhindern kann. Zwei pivotale Phase-III-Studien (NAVIGATE ESUS, RE-SPECT ESUS) haben diese Erwartung nicht bestätigt. ESUS ist keine singuläre pathogenetische Entität. Zukünftige Konzepte müssen das berücksichtigen, um einer personalisierten Therapie den Weg zu ebnen.

 

  • Literatur

  • 1 Adams Jr. HP, Bendixen BH, Kappelle LJ. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35-41
    CrossrefPubMedSearch in Google Scholar
  • 2 Hart RG, Diener HC, Coutts SB. et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014; 13: 429-438
    CrossrefPubMedSearch in Google Scholar
  • 3 Hart RG, Catanese L, Perera KS. et al. Embolic Stroke of Undetermined Source: A Systematic Review and Clinical Update. Stroke 2017; 48: 867-872
    CrossrefPubMedSearch in Google Scholar
  • 4 European Stroke Organisation Executive C, Committee ESOW. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25: 457-507
    CrossrefPubMedSearch in Google Scholar
  • 5 Furie KL, Kasner SE, Adams RJ. et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke 2011; 42: 227-276
    CrossrefPubMedSearch in Google Scholar
  • 6 Cotter PE, Martin PJ, Ring L. et al. Incidence of atrial fibrillation detected by implantable loop recorders in unexplained stroke. Neurology 2013; 80: 1546-1550
    CrossrefPubMedSearch in Google Scholar
  • 7 Ritter MA, Kochhauser S, Duning T. et al. Occult Atrial Fibrillation in Cryptogenic Stroke: Detection by 7-Day Electrocardiogram Versus Implantable Cardiac Monitors. Stroke 2013; 44: 1449-1452
    CrossrefPubMedSearch in Google Scholar
  • 8 Sanna T, Diener HC, Passman RS. et al. Cryptogenic stroke and underlying atrial fibrillation. New Engl J Med 2014; 370: 2478-2486
    CrossrefPubMedSearch in Google Scholar
  • 9 Poli S, Diedler J, Härtig F. et al. Insertable cardiac monitors after cryptogenic stroke – a risk factor based approach to enhance the detection rate for paroxysmal atrial fibrillation. Eur J Neurol 2016; 23: 375-381
    CrossrefPubMedSearch in Google Scholar
  • 10 Hart RG, Sharma M, Mundl H. et al. Rivaroxaban for secondary stroke prevention in patients with embolic strokes of undetermined source: Design of the NAVIGATE ESUS randomized trial. Eur Stroke J 2016; 1: 146-154
    CrossrefPubMedSearch in Google Scholar
  • 11 Diener HC, Easton JD, Granger CB. et al. Design of Randomized, double-blind, Evaluation in secondary Stroke Prevention comparing the EfficaCy and safety of the oral Thrombin inhibitor dabigatran etexilate vs. acetylsalicylic acid in patients with Embolic Stroke of Undetermined Source (RE-SPECT ESUS). Int J Stroke: official journal of the International Stroke Society 2015; 10: 1309-1312
    PubMedSearch in Google Scholar
  • 12 Geisler T, Poli S, Meisner C. et al. Apixaban for treatment of embolic stroke of undetermined source (ATTICUS randomized trial): Rationale and study design. Int J Stroke 2017; 12: 985-990
    CrossrefPubMedSearch in Google Scholar
  • 13 Thijs VN, Brachmann J, Morillo CA. et al. Predictors for atrial fibrillation detection after cryptogenic stroke: Results from CRYSTAL AF. Neurology 2016; 86: 261-269
    CrossrefPubMedSearch in Google Scholar
  • 14 Hart RG, Sharma M, Mundl H. et al. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. New Engl J Med 2018; 378: 2191-2201
    CrossrefPubMedSearch in Google Scholar
  • 15 Hankey GJ, Patel MR, Stevens SR. et al. Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF. Lancet Neurol 2012; 11: 315-322
    CrossrefPubMedSearch in Google Scholar
  • 16 Verma N, Ziegler PD, Liu S. et al. Incidence of atrial fibrillation among patients with an embolic stroke of undetermined source: Insights from insertable cardiac monitors. Int J Stroke 2018 DOI: 10.1177/1747493018798554: 1747493018798554
    PubMedSearch in Google Scholar
  • 17 Kasner SE, Swaminathan B, Lavados P. et al. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial. Lancet Neurol 2018; 17: 1053-1060
    CrossrefPubMedSearch in Google Scholar
  • 18 Patel MR, Mahaffey KW, Garg J. et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New Engl J Med 2011; 365: 883-891
    CrossrefPubMedSearch in Google Scholar
  • 19 Hart RG, Tonarelli SB, Pearce LA. Avoiding central nervous system bleeding during antithrombotic therapy recent – Data and ideas. Stroke 2005; 36: 1588-1593
    CrossrefPubMedSearch in Google Scholar
  • 20 Lip GYH, Keshishian A, Li X. et al. Effectiveness and Safety of Oral Anticoagulants Among Nonvalvular Atrial Fibrillation Patients. The ARISTOPHANES Study. Stroke 2018; 49: 2933-2944
    CrossrefPubMedSearch in Google Scholar
  • 21 Amarenco P, Albers GW, Denison H. et al. Ticagrelor Versus Aspirin in Acute Embolic Stroke of Undetermined Source. Stroke 2017; 48: 2480-2487
    CrossrefPubMedSearch in Google Scholar
  • 22 Ntaios G, Papavasileiou V, Lip GY. et al. Embolic Stroke of Undetermined Source and Detection of Atrial Fibrillation on Follow-Up: How Much Causality Is There?. J Stroke Cerebrovasc Dis 2016; 25: 2975-2980
    CrossrefPubMedSearch in Google Scholar