Accidente cerebrovascular embólico de origen indeterminado. El concepto ESUS

Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain as a diagnostic and therapeutic challenge. Embolic stroke of unknown source (ESUS) is caused by embolic disease and associated with an elevated risk of recurrent ischemic strokes and clinically silent cerebral ischemic lesions. Optimal secondary prevention of ESUS is not established. The current standard in these patients is acetylsalicylic acid, despite high prevalence of yet undetected paroxysmal atrial fibrillation and other potential embolic etiologies. Long-term mortality risk in ESUS is lower compared with cardioembolic strokes, despite similar rates of recurrence and composite cardiovascular end point. Recurrent stroke risk is higher in ESUS than in noncardioembolic strokes.