ISC 2024 | The future of clinical trials for ESUS

Aristeidis Katsanos, MD, McMaster University, Hamilton, Ontario, Canada, discusses the concept of embolic stroke of undetermined source (ESUS), outlining the clinical trial data in this field to date. ESUS describes cases of nonlacunar, cryptogenic, ischemic stroke where embolism is the likely stroke mechanism. Several trials have investigated the hypothesis that anticoagulation is more efficacious than antiplatelet therapy for secondary stroke prevention in ESUS, but all have failed to show superiority of anticoagulation for stroke recurrence. Two trials enrolled an ‘enriched ESUS’ population, aiming to increase the chance of stroke being due to a cardioembolic source, but these trials were also neutral. Dr Katsanos suggests that these findings are most likely due to a large proportion of ESUS being caused by atherosclerosis. This hypothesis is informing future trials in the ESUS space. This interview took place during the International Stroke Conference 2024 in Phoenix, AZ.

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