{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:29:13Z","timestamp":1786739353113,"version":"build-2736575974"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T00:00:00Z","timestamp":1751068800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives:<\/jats:title>\n                    <jats:p>Embolic stroke of undetermined source (ESUS) was introduced to standardize the classification of cryptogenic strokes with presumed embolic origin. However, ESUS comprises a heterogeneous group with diverse clinical and diagnostic features. This study aimed to characterize ESUS within a prospective stroke cohort and compare it with other defined ischemic stroke subtypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this prospective, single-center study, patients with acute ischemic stroke or transient ischemic attack (TIA) were enrolled over 6 months. Stroke etiology was classified according to established criteria, including ESUS definitions based on the exclusion of major cardioembolic sources, \u226550% large-artery stenosis, and small-vessel disease. All patients underwent neuroimaging, vascular diagnostics, and cardiological workup, including echocardiography and rhythm monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of 714 patients, 98 (13.7%) met ESUS criteria. ESUS patients were younger (median 67 vs. 74 years), predominantly male (61.2%), and had fewer prior strokes or TIAs (11.2% vs. 27.6%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) than nonESUS patients. Hypertension (72.2%) and obesity (54.2%) were common. Stroke severity at discharge was lower in ESUS (National Institutes of Health Stroke (NIHSS) 1.9 \u00b1 2.3) compared to cardioembolic (4.8 \u00b1 3.7) and atherosclerotic strokes (3.5 \u00b1 3.1) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05), and no in-hospital deaths occurred in the ESUS group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.02). While overall diagnostic imaging rates were similar across groups, transesophageal echocardiography was performed more frequently in ESUS (38.8%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>ESUS accounted for 18% of ischemic strokes and represents a distinct, clinically relevant subgroup with unique demographic and outcome profiles. These findings support the refinement of ESUS classification and the need for individualized diagnostic and secondary prevention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aian.aian_327_25","type":"journal-article","created":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T12:01:27Z","timestamp":1751112087000},"page":"684-692","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Embolic Stroke of Undetermined Source (ESUS): Prevalence, Risk Factors, and Diagnostic Insights from a Prospective German Cohort"],"prefix":"10.4103","volume":"28","author":[{"given":"Priyanka","family":"Boettger","sequence":"first","affiliation":[{"name":"Department of Cardiology, Angiology and Critical Care Medicine, Justus Liebig University, Gie\u00dfen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamschid","family":"Sedighi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Critical Care Medicine, Justus Liebig University, Gie\u00dfen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Juenemann","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurological Intensive Care, Justus Liebig University, Gie\u00dfen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Buerke","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Critical Care Medicine, St. Marien Krankenhaus, Siegen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar Alhaj","family":"Omar","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurological Intensive Care, Justus Liebig University, Gie\u00dfen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,28]]},"reference":[{"key":"R1-20251112","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/S1474-4422(13)70310-7","article-title":"Embolic strokes of undetermined source: The case for a new clinical construct","volume":"13","author":"Hart","year":"2014","journal-title":"Lancet Neurol"},{"key":"R2-20251112","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1056\/NEJMoa1813959","article-title":"Dabigatran for prevention of stroke after embolic stroke of undetermined source","volume":"380","author":"Diener","year":"2019","journal-title":"N Engl J Med"},{"key":"R3-20251112","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1056\/NEJMoa1802686","article-title":"Rivaroxaban for stroke prevention after embolic stroke of undetermined source","volume":"378","author":"Hart","year":"2018","journal-title":"N Engl J Med"},{"key":"R4-20251112","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s11239-019-01951-5","article-title":"Age-related burden and characteristics of embolic stroke of undetermined source in the real world clinical practice","volume":"49","author":"Grifoni","year":"2020","journal-title":"J Thromb Thrombolysis"},{"key":"R5-20251112","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1007\/s10072-018-3322-5","article-title":"Embolic strokes of undetermined source in a cohort of Polish stroke patients","volume":"39","author":"Bembenek","year":"2018","journal-title":"Neurol Sci"},{"key":"R6-20251112","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1161\/STROKEAHA.114.007240","article-title":"Embolic strokes of undetermined source in the Athens stroke registry: A descriptive analysis","volume":"46","author":"Ntaios","year":"2015","journal-title":"Stroke"},{"key":"R7-20251112","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1056\/NEJMoa011258","article-title":"A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke","volume":"345","author":"Mohr","year":"2001","journal-title":"N Engl J Med"},{"key":"R8-20251112","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1177\/1747493016641967","article-title":"Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry","volume":"11","author":"Perera","year":"2016","journal-title":"Int J Stroke"},{"key":"R9-20251112","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/S1047-9651(18)30162-1","article-title":"The National Institutes of Health Stroke Scale and its importance in acute stroke management","volume":"10","author":"Odderson","year":"1999","journal-title":"Phys Med Rehabil Clin N Am"},{"key":"R10-20251112","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1161\/01.STR.28.2.307","article-title":"Reliability of the National Institutes of Health Stroke Scale. 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