Supracardiac Atherosclerotic Lesions in Embolic Stroke of Undetermined Source: Predicting Stroke Recurrence and Enhancing Secondary Prevention Strategies
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background Identifying the potential cause of embolic stroke of undetermined source is essential for secondary prevention. We analyzed retrospectively collected real‐world data from the South Korean cohort with embolic stroke of undetermined source to examine trends in baseline characteristics, diagnostic practices, and secondary prevention strategies and to identify cardioembolic factors and supracardiac atherosclerotic lesions associated with stroke recurrence. Methods We analyzed 5787 patients from the Real‐World Study of Embolic Stroke of Undetermined Source cohort from 19 South Korean stroke centers (2014–2019). Baseline characteristics, diagnostic and secondary prevention trends were evaluated. Factors associated with 1‐year stroke recurrence were identified using multivariable Cox regression analysis in 4036 patients with follow‐up data. Results Over 6 years, vascular risk factors and cardioembolic evaluations significantly increased. Stroke recurrence was strongly associated with intracranial nonrelevant stenosis involving ≥2 vessels (hazard ratio [HR], 2.756, P <0.001), paroxysmal atrial fibrillation (HR, 5.590, P =0.033), atrial septal aneurysm (HR, 4.741, P =0.005), and serum creatinine levels (HR, 1.166, P =0.008). In patients without moderate‐risk cardioembolic sources, a single intracranial nonrelevant stenosis and complex aortic atheroma were also linked to stroke recurrence. Conclusions Intracranial nonrelevant stenosis and complex aortic atheroma, along with cardioembolic factors like paroxysmal atrial fibrillation and atrial septal aneurysm, are key predictors of stroke recurrence in embolic stroke of undetermined source, especially those without moderate‐risk cardioembolic sources. These findings emphasize the need to consider both supracardiac atherosclerotic and cardioembolic mechanisms in embolic stroke of undetermined source and to develop tailored secondary prevention strategies for atherosclerotic stroke, particularly in cases with supracardiac atherosclerotic lesions to reduce stroke recurrence.
Authors: Hyung Jun Kim, Hyung Jun Kim, Hyun Kyung Kim, Hyun Kyung Kim, Jang‐Hyun Baek, Hahn Young Kim, Hahn Young Kim, Yang‐Ha Hwang, Sung Hyuk Heo, Ho Geol Woo, Hyungjong Park, Sung‐Il Sohn, Chi Kyung Kim, Jin‐Man Jung, Sang‐Hun Lee, Jae‐Kwan Cha, Hee‐Joon Bae, Beom Joon Kim, Sun Uck Kwon, Bum Joon Kim, Ji Sung Lee, Hyo Suk Nam, Jee‐Hyun Kwon, Wook‐Ju Kim, Hee‐Kwon Park, Man‐Seok Park, Kang‐Ho Choi, Jay Chol Choi, Joong‐Goo Kim, Chul‐Hoo Kang, Kwang Yeol Park, Young Seo Kim, Gyeong‐Moon Kim, Oh Young Bang, Jong‐Won Chung, Sung‐A Chang, Tae‐Jin Song, Moo‐Seok Park, Min Kyoung Kang, Woo‐Keun Seo
Institutions: Konkuk University, Samsung Medical Center, Sungkyunkwan University, Kangbuk Samsung Hospital, Konkuk University Medical Center, Kyungpook National University, Kyung Hee University Medical Center, Keimyung University, Korea University Guro Hospital, Inha University Hospital, Korea University Ansan Hospital, Dong-A University Hospital, Seoul National University Bundang Hospital, Asan Medical Center, University of Ulsan, Yonsei University, Ulsan University Hospital, Inha University, Chonnam National University, Chonnam National University Hospital, Jeju National University Hospital, Ewha Womans University, Ewha Womans University Seoul Hospital, Chung-Ang University Healthcare System, Chung-Ang University, Hanyang University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
OpenAlex ID: W4416127397