Angelo Cascio Rizzo: Ischemic Stroke Phenotyping in ESUS – Insights from a Real-World Cohort
Angelo Cascio Rizzo, Angelo Cascio Rizzo, Vascular Neurologist at Niguarda Ca’ Granda Hospital, shared a post on LinkedIn about a recent article he and his colleagues co-authored, published in Journal of the American Heart Association, adding:
“Check out our latest paper published in the JAHA — Journal of the American Heart Association.
We assessed how the Ischemic Stroke Phenotyping System 2025 performs in 802 consecutive patients with ESUS admitted to Niguarda Hospital in Milan.
Key findings:
- ISPS25 assigned a pathogenetic category to 313 patients (39.0%), most commonly cardioembolism.
- The remaining 489 patients (61.0%) still classified as undetermined?
- Second-pass diagnostic testing was performed less often in patients who remained undetermined than in those who were reassigned (46.2% vs 70.3%).
- Additional potential embolic sources outside the ISPS25 framework were more frequent in undetermined patients (62.0% vs 42.5%). These included atrial cardiopathy, AFib first detected more than 12 months after stroke, high-risk PFO in patients aged 60 years or older, and nonstenotic carotid plaque with increased wall thickness.
ISPS25 is a useful tool for stroke classification.
To identify more potential mechanisms, we need more complete diagnostic testing and a broader assessment of potential embolic sources.”
Title: Application of the Ischemic Stroke Phenotyping System 2025 in a Real‐World Embolic Stroke of Undetermined Source Cohort: Advantages and Limitations
Authors: Angelo Cascio Rizzo, Ghil Schwarz
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