Clinical events encountered in the long-term course of ESUS patients and associated factors: A single-center experience

Introduction: Embolic stroke of undetermined source (ESUS) describes ischemic stroke cases in which no specific etiology can be identified. Clinical events that occur during long-term follow-up play a critical role in clarifying the hidden etiology. The aim of this study was to evaluate the frequency of recurrent stroke, atrial fibrillation (AF), malignancy, and mortality during long-term follow-up of 152 ESUS cases, and the association of these outcomes with clinical and demographic variables.Methods: We retrospectively included 152 ESUS patients who were regularly followed for 2–8 years (median: 5 years). Baseline demographic data, vascular risk factors, and stroke localizations (carotid, vertebrobasilar, both anterior and posterior systems) were recorded. AF, malignancy, recurrent stroke, and mortality events that developed during follow-up were analyzed. The Mann-Whitney U, Fisher exact, and Fisher-Freeman-Halton exact tests were used for statistical evaluation; a p value <0.05 was considered significant.Results: The mean age of the patients was 64.16±12.00 years; 57.0% (n=87) were men and 43.0% (n=65) were women. Stroke localization was carotid in 62.5% (n=95), vertebrobasilar in 32.9% (n=50), and both systems in 4.6% (n=7). During follow-up, recurrent stroke developed in 36.8% of the patients (n=56; 30 ischemic, 3 hemorrhagic, 23 multiple), mortality in 15.0% (n=23), malignancy in 6.0% (n=9), and AF in 4.0% (n=6). No significant association was found between recurrent stroke and age, sex, stroke localization, or comorbidities (HTN, DM, HLD, CAD) (p>0.05). Although the frequency of HTN (p=0.313) and the proportion of men (p=0.094) were higher in the multiple recurrent stroke group, the differences did not reach statistical significance. The mean age of the patients who died (73.7±9.8 years) was significantly higher than that of those who did not (62.4±12.0 years) (p=0.001) (Table 1–3).Discussion/Conclusion: Long-term prognosis in ESUS patients is heterogeneous, and advanced age is an independent predictor of mortality. Over five years of follow-up, a potential etiological cause (AF or malignancy) was identified in 10.0% of the cases (n=15). This indicates that the etiological work-up is a dynamic process that should be continued throughout life. In addition to vascular risk control and antiplatelet therapy, extended or device-based rhythm monitoring is recommended for the detection of AF.Keywords: