Pathophysiology of cryptogenic stroke identified by transesophageal echocardiography multicenter study : CHALLENGE ESUS/CS registry

Cryptogenic stroke is not uncommon. In 2014, embolic of undetermined source (ESUS) was advocated, two clinical trials for ESUS comparing the efficacy direct oral anticoagulants (DOACs) and aspirin have failed to show any benefits DOACs over aspirin, possibly due heterogeneous mechanisms in ESUS. Transesophageal echocardiography (TEE) useful screen potential sources such as patent foramen ovale, atrial septal aneurysm, aortic arch plaques ESUS/cryptogenic stroke. The Mechanisms Embolic Stroke Clarified by Echocardiography Undetermined Source/Cryptogenic (CHALLENGE ESUS/CS) registry a multicenter enrolling consecutive patients with CS who underwent TEE among 8 hospitals Japan between April 2014 December 2016. Inclusion criteria were: 1) ≥ 20 years age within 7 days onset; 2) non-lacunar on neuroradiological imaging; 3) absence arterial stenosis 50% or occlusion corresponding large artery; 4) major embologenic cardiac diseases; 5) other determined etiologies. this paper, results from CHALLENGE ESUS/CS are reviewed, pathomechanisms cryptogenic discussed.