“The old concept of cryptogenic stroke is not very useful if you want to do randomized trials in a defined population and this is why we created the definition of ESUS,” Dr. Diener said.
“In the future, we have two ways to address this problem. One way is much more sophisticated diagnostic testing to detect silent AF and the other way is to treat and to improve the medical treatment of these patients. Hopefully, three years from now, we have evidence that we have something to offer that is superior to aspirin and has a superior side effect profile.”
Introducing the concept of ESUS has not been not without its critics, however, and in a comment published in the Lancet Neurology, Dr. Martin Dennis of the Western General Hospital in Edinburgh, Scotland, pointed out that the name selected might mislead clinicians.
“An unknown proportion of patients with ESUS will not have an embolic stroke, but a stroke due to in-situ thrombosis,” he argued. “Although one can see the advantages of the name for gaining support from funders and clinicians for a trial, and for marketing new oral anticoagulants if they prove effective, the name will mislead clinicians.”
Dr. Dennis suggested that a better name might be to refer to these strokes as “non-lacunar ischaemic stroke without a defined cause”.
Dr. Diener and his institution have received financial support from a number of German and European funding bodies, and wide range of pharmaceutical companies.