Age-related burden and characteristics of embolic stroke of undetermined source in the real world clinical practice.

Few data are available on age-related burden and characteristics of embolic stroke of undetermined source (ESUS) in the real world clinical practice. The aim of our study was to provide information about it. We retrospectively analyzed data of patients consecutively admitted to our Stroke Unit along 1 year (2017, November 1st-2018, October 31st). The etiology of ischemic stroke was defined at hospital discharge; ESUS was considered as a subset of cryptogenic stroke, and defined according to the 2014 international criteria. In the analyzed period, 306 patients, 52.3% females, mean age ± SD 77.9 ± 11.9 years, were discharged with diagnosis of ischemic stroke. Ischemic strokes of cardioembolic and lacunar origin were the most frequent subtypes: 30.1% and 29.4%, respectively. Cardioembolic strokes were particularly frequent in patients ≥ 75 years, and almost always associated with atrial fibrillation. Overall, in 80 patients (26.1%) the etiology of stroke was undetermined; in 25 (8.2%) it remained undefined because of death or severe comorbidity, making further diagnostic work-up not worthy. Cryptogenic stroke occurred in 55 patients (18%), and ESUS criteria were satisfied in 39 of them (12.7%). According to age, cryptogenic stroke was diagnosed in 21.1% (21.1% ESUS) of patients < 65 years, 24.2% (19.4% ESUS) of patients aged 65-74 years, 15.5% (9.2% ESUS) of patients ≥ 75 years. After diagnostic work-up, patent foramen ovale was most commonly associated with ESUS (17.9%), especially in patients < 65 years (62.5%); covert paroxysmal atrial fibrillation was detected in 10.5% of ESUS patients ≥ 75 years. In the real world clinical practice, the frequency of ischemic strokes of undetermined etiology, and of those satisfying ESUS criteria, is not negligible, especially in younger patients. A thorough diagnostic work-up, with an age-specific approach, is therefore necessary and of the utmost importance for the identification of stroke etiology, in order to optimize secondary stroke prevention strategies.

Clinical expression of coronary artery ectasia.

OBJECTIVE: Coronary artery ectasia (CAE) is an uncommon finding at cardiac catheterisation. Our objective was to retrospectively assess the angiographic prevalence of CAE and its clinical expression. METHODS: From January 1999 to June 2001, 3870 consecutive patients underwent coronary angiography at our catheterisation laboratory. RESULTS: The prevalence of CAE was 3.6%. Most patients were male (89.2%). Type 1 CAE was observed in 20% of patients, type 2 in 11%, type 3 in 43%, and type 4 in 26%. The right coronary artery was most commonly involved (75%). In 55 patients with acute myocardial infarction, CAE within the culprit vessel was found in 32 patients (58.1%): ectasia was associated with stenosis in 29 patients, whereas isolated CAE was observed in only three patients. In 23 patients (41.8%), CAE was detected as a collateral finding in the presence of the culprit occluded, non-ectatic vessel. Overall, in the 109 patients (78%) with acute coronary syndrome, the culprit lesion was found to be related to the ectatic vessel in 46 patients (33.1%): ectasia was associated with stenosis in 39 patients, whereas isolated CAE was observed in only seven patients. In 66.9% CAE was an incidental finding on angiography. At follow-up, three patients with CAE died (2%). CONCLUSIONS: In our investigation, the angiographic prevalence of CAE was 3.6%. CAE occurred predominantly in males and more often affected the right coronary artery. It was associated with acute coronary syndrome in one third of cases. Isolated CAE was associated with a good prognosis at follow-up.