关键词: 不明原因栓塞性卒中; 24 h心电监测; 抗栓; 复发

Abstract:

Objective To investigate the current status of diagnosis and treatment of embolic stroke of undetermined source (ESUS) in patients hospitalized for ischemic stroke in China. Methods A retrospective review of clinical data of inpatients for ischemic stroke in Peking University Third Hospital between Jan 2011 and Dec 2012 was conducted. Patients who did not receive 24-hour Holter monitoring, yet had completed the other evaluations and met ESUS diagnostic criteria of ESUS International Working Group were defined as “suspected ESUS” (sESUS), while those who completed all relative evaluations (including 24-hour Holter monitoring) and met the diagnostic criteria of ESUS were defined as “definite ESUS” (dESUS). All the above patients were enrolled into ESUS group, and the other subtypes of stroke as control. The baseline charateristics, risk factors and clinical features were compared between the two groups. Secondary prevention and stroke recurrence of these ESUS patients (including sESUS and dESUS) after discharge were followed up. Results Finally, 900 patients with ischemic stroke were enrolled in this study, of which 9 dESUS (1.0%) and 95 sESUS (10.6%), the 104 ESUS patients accounted for 11.6% (104/900) of all subjects,

and the remaining 796 patients were divided into non-ESUS group. Clinical features of two groups as follows: 85 onset during physical activities (81.7%), 58 ones with fluctuating symptoms (55.8%) and the mean score of National Institutes of Health Stroke Scale (NIHSS) was 2.0 (0, 4.0) in ESUS group; the corresponding in control group was 538 (67.6%) , 245 (30.8%) and 3.0 (1.3, 5.0), respectively; there was significant difference in any of the three between two groups (P =0.010, P <0.001, P <0.001, respectively). Analyzing the usage of antithrombotic drugs in acute phase and after discharge in ESUS patients, we found that all ESUS patients had taken antiplatelet agents, and 6 dESUS and 10 sESUS patients experienced recurrent stroke during the first year after discharge. Conclusion Patients diagnosed as ESUS is very common in patients with ischemic stroke. Comparing with non-ESUS patients, there were more fluctuating symptoms and less neurologic deficit in ESUS ones. 24-hour Holter monitoring in ESUS patients is necessary and very helpful for determing the cause of stroke.

Key words: Embolic stroke of undetermined source; 24-hour Holter monitoring; Antithrombotic therapy; Stroke recurrence