Contemporary Statistics of Acute Ischemic Stroke and Transient Ischemic Attack in 2021: Insights From the CRCS-K-NIH Registry.

This report presents the latest statistics on the stroke population in South Korea, sourced from the Clinical Research Collaborations for Stroke in Korea-National Institute for Health (CRCS-K-NIH), a comprehensive, nationwide, multicenter stroke registry. The Korean cohort, unlike western populations, shows a male-to-female ratio of 1.5, attributed to lower risk factors in Korean women. The average ages for men and women are 67 and 73 years, respectively. Hypertension is the most common risk factor (67%), consistent with global trends, but there is a higher prevalence of diabetes (35%) and smoking (21%). The prevalence of atrial fibrillation (19%) is lower than in western populations, suggesting effective prevention strategies in the general population. A high incidence of large artery atherosclerosis (38%) is observed, likely due to prevalent intracranial arterial disease in East Asians and advanced imaging techniques. There has been a decrease in intravenous thrombolysis rates, from 12% in 2017-2019 to 10% in 2021, with no improvements in door-to-needle and door-to-puncture times, worsened by the coronavirus disease 2019 pandemic. While the use of aspirin plus clopidogrel for non-cardioembolic stroke and direct oral anticoagulants for atrial fibrillation is well-established, the application of direct oral anticoagulants for non-atrial fibrillation cardioembolic strokes in the acute phase requires further research. The incidence of early neurological deterioration (13%) and the cumulative incidence of recurrent stroke at 3 months (3%) align with global figures. Favorable outcomes at 3 months (63%) are comparable internationally, yet the lack of improvement in dependency at 3 months highlights the need for advancements in acute stroke care.

Mechanical Thrombectomy for Hyperacute Vertebrobasilar Ischemic Stroke via Nondominant Vertebral Artery : Clinical Experience and Considerations.

Objective: The dominant vertebral artery (VA) approach is primarily considered in mechanical thrombectomy (MT) for acute occlusion of the vertebrobasilar (VB) artery. As accessing the dominant artery is sometimes difficult, we present our experience treating acute VB stroke via a nondominant VA approach through a comparison with the dominant VA approach. Methods: Among 2,785 patients diagnosed with hyperacute ischemic stroke between January 2014 and December 2022, 50 patients with VB ischemic stroke underwent recanalization therapy through either dominant, nondominant, or bilateral VA approach. We evaluated patient characteristics and clinical course, highlighting the pros and cons of the access routes. Results: The patients with hyperacute VB ischemic stroke were predominantly male (72%), with a mean age of 68.12 years and an initial National Institutes of Health Stroke Scale (NIHSS) score mean of 17.1. Large-artery atherosclerosis (LAA, 48%) and cardio-embolism (CE, 36%) were the main etiologic factors in the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification. After thrombectomy, 45 (90%) cases had final modified thrombolysis in cerebral infarction (mTICI) score of 2b or higher. In summary, 41 patients were treated through the dominant VA, and 8 patients underwent the nondominant VA approach. However, there was no statistically significant difference in functional outcome or mortality between the two approaches. Conclusion: In MT for VB occlusions, nondominant VA approach may be an option in situations when the vessel is accessible, stable, or less risky, as recanalization can be achieved without rescue balloon angioplasty and/or stenting.

Instrumental variable and colocalization analyses identify endotrophin and HTRA1 as potential therapeutic targets for coronary artery disease.

Coronary artery disease (CAD) remains a leading cause of disease burden globally, and there is a persistent need for new therapeutic targets. Instrumental variable (IV) and genetic colocalization analyses can help identify novel therapeutic targets for human disease by nominating causal genes in genome-wide association study (GWAS) loci. We conducted cis-IV analyses for 20,125 genes and 1,746 plasma proteins with CAD using molecular trait quantitative trait loci variant (QTLs) data from three different studies. 19 proteins and 119 genes were significantly associated with CAD risk by IV analyses and demonstrated evidence of genetic colocalization. Notably, our analyses validated well-established targets such as PCSK9 and ANGPTL4 while also identifying HTRA1 and endotrophin (a cleavage product of COL6A3) as proteins whose levels are causally associated with CAD risk. Further experimental studies are needed to confirm the causal role of the genes and proteins identified through our multiomic cis-IV analyses on human disease.

A Case of Severe Delayed Vasospasm after Clipping Surgery for an Unruptured Intracranial Aneurysm.

Delayed ischemic stroke associated with intractable vasospasm after clipping of unruptured intracranial aneurysms (UIAs) has been rarely reported. We report a patient with delayed ischemic stroke associated with intractable vasospasm following UIA clipping. A middle-aged female underwent surgery for unruptured middle cerebral artery bifurcation aneurysms. The patient tolerated the neurosurgical procedure well. Seven days postoperatively, the headache was unbearable; a postcraniotomy headache persisted and abruptly presented with global aphasia and right-sided hemiplegia after a nap. Emergency digital subtraction angiography showed severe luminal narrowing with segmental vasoconstriction, consistent with severe vasospasm. The patient's neurological deficit improved after chemical angioplasty. Neurosurgeons should pay close attention to this treatable/preventive entity after neurological deterioration following UIA clipping, even in patients without subarachnoid hemorrhage.

Ionizing terahertz waves with 260 MV/cm from scalable optical rectification.

Terahertz (THz) waves, known as non-ionizing radiation owing to their low photon energies, can actually ionize atoms and molecules when a sufficiently large number of THz photons are concentrated in time and space. Here, we demonstrate the generation of ionizing, multicycle, 15-THz waves emitted from large-area lithium niobate crystals via phase-matched optical rectification of 150-terawatt laser pulses. A complete characterization of the generated THz waves in energy, pulse duration, and focal spot size shows that the field strength can reach up to 260 megavolts per centimeter. In particular, a single-shot THz interferometer is employed to measure the THz pulse duration and spectrum with complementary numerical simulations. Such intense THz pulses are irradiated onto various solid targets to demonstrate THz-induced tunneling ionization and plasma formation. This study also discusses the potential of nonperturbative THz-driven ionization in gases, which will open up new opportunities, including nonlinear and relativistic THz physics in plasma.

Characteristics and Trends of Pediatric Trauma in Jeju Island, South Korea: A Community Level Serial Cross-sectional study.

Objective: This study aimed to investigate the characteristics and epidemiological trends of pediatric injuries among patients visiting emergency departments (EDs) on Jeju Island. Method: Employing a community-level serial cross-sectional analysis, we targeted pediatric patients aged 18 years or younger who visited EDs for injuries over a ten-year period. The data, sourced from the Jeju Injury Surveillance System (JISS), facilitated a comprehensive examination of injury characteristics and epidemiological trends. This included an evaluation of the annual incidence and overall trends in pediatric injury cases. Results: The study found toddlers (42.5% of cases) to be the most frequently injured age group. Males were more prone to injuries, with a male-to-female ratio of 1.7:1. Injuries among visitors accounted for 17.3% of cases, with a seasonal spike in Summer, evenings and weekends. Most incidents occurred at home, predominantly accidental in nature, with adolescents more likely to require EMS services. The common mechanisms of injuries were blunt force (49.2%), slips/falls (22.0%), and motor vehicle collisions (13.2%), leading to bruises, cuts, and sprains. Over the decade, a general increase in pediatric injuries was observed. Accidental injuries initially surged but later stabilized, while self-harm/suicide and assault/violence injuries showed a concerning upward trend. Age-specific analysis revealed increasing trends in infants and adolescents. Conclusion: The study underscores the crucial need for targeted injury prevention and resource allocation strategies, particularly for high-risk groups and times, to effectively mitigate pediatric trauma on Jeju Island.

Functionalization of niobium nitrogen-doped titanium dioxide (TiO2) nanoparticles with ethanolic extracts of Mentha arvensis.

Titanium dioxide (TiO2) nanoparticles have gained significant attention due to their wide-ranging applications. This research explores an approach to functionalize Niobium Nitrogen Titanium Dioxide nanoparticles (Nb-N-TiO2 NPs) with Mentha arvensis ethanolic leaf extracts. This functionalization allows doped NPs to interact with the bioactive compounds in extracts, synergizing their antioxidant activity. While previous studies have investigated the antioxidant properties of TiO2 NPs synthesized using ethanolic extracts of Mentha arvensis, limited research has focused on evaluating the antioxidant potential of doped nanoparticles functionalized with plant extracts. The characterization analyses are employed by Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and Ultraviolet-visible (UV-Vis) spectroscopy to evaluate these functionalized doped nanoparticles thoroughly. Subsequently, the antioxidant capabilities through the 2,2-diphenyl-1-picrylhydrazyl (DPPH) and ferric-reducing antioxidant power (FRAP) assays have been assessed. Within functionalized Nb-N-TiO2, the FTIR has a distinctive peak at 2350, 2010, 1312, 1212, and 1010 cm-1 with decreased transmittance associated with vibrations linked to the Nb-N bond. SEM revealed a triangular aggregation pattern, 500 nm to 2 µm of functionalized Nb-N-TiO2 NPs. Functionalized doped Nb-N-TiO2 NPs at 500 µg mL-1 exhibited particularly robust antioxidant activity, achieving an impressive 79% efficacy at DPPH assessment; meanwhile, ferric reduction efficiency of functionalized doped Nb-N-TiO2 showed maximum 72.16%. In conclusion, doped Nb-N-TiO2 NPs exhibit significantly enhanced antioxidant properties when functionalized with Mentha arvensis ethanolic extract compared to pure Nb-N-TiO2 manifested that doped Nb-N-TiO2 have broad promising endeavors for various biomedicine applications.

Prevalence of shoulder pain and its correlates in Jeju agricultural population: A retrospective cross-sectional study.

The aim of this study was to investigate the prevalence of shoulder pain and analyze its association with socio-demographic factors, agricultural work-related conditions, and biomechanical factors among farmers on Jeju Island. We utilized initial survey data from the Safety for Agricultural Injury of Farmers' cohort study involving adult farmers on Jeju Island. The presence and characteristics of shoulder pain, socio-demographics, agricultural work-related conditions, and biomechanical factors were assessed using semi-structured questionnaires. A total of 1206 participants were analyzed for prevalence and associated risk factors using frequency and multivariate logistic regression analyses. The overall prevalence of shoulder pain was 17%. Multivariate logistic regression analysis, adjusted for significant socio-demographic and agricultural work-related condition variables, revealed that stress level, type of farming, and experiencing an agricultural injury within the preceding year were significantly associated with shoulder pain (stress level: "occasional," adjusted odds ratio [aOR], 1.581; 95% confidence interval [CI], 1.079-2.318; "frequent," aOR, 1.964; 95% CI, 1.205-3.200; and "extreme," aOR, 2.999; 95% CI, 1.480-6.074 vs "rarely"; type of farming: "orchard," aOR, 0.82; 95% CI, 0.597-1.124; "livestock," aOR, 0.225; 95% CI, 0.079-0.641 vs "field"; and experienced an agricultural injury within the past year: "yes," aOR, 2.078; 95% CI, 1.269-3.405). In addition, 3 biomechanical factors significantly contributed to shoulder pain: activities requiring significant power such as shoveling, pickaxing, and hammering; repetitive use of a particular body part; and constant elevation of the arm above the head. The findings highlight the importance of postural education, injury prevention, and psychological support in managing shoulder pain among farmers.

Organ-on-Chip: Advancing Nutraceutical Testing for Improved Health Outcomes.

The recent global wave of organic food consumption and the vitality of nutraceuticals for human health benefits has driven the need for applying scientific methods for phytochemical testing. Advanced in vitro models with greater physiological relevance than conventional in vitro models are required to evaluate the potential benefits and toxicity of nutraceuticals. Organ-on-chip (OOC) models have emerged as a promising alternative to traditional in vitro models and animal testing due to their ability to mimic organ pathophysiology. Numerous studies have demonstrated the effectiveness of OOC models in identifying pharmaceutically relevant compounds and accurately assessing compound-induced toxicity. This review examines the utility of traditional in vitro nutraceutical testing models and discusses the potential of OOC technology as a preclinical testing tool to examine the biomedical potential of nutraceuticals by reducing the need for animal testing. Exploring the capabilities of OOC models in carrying out plant-based bioactive compounds can significantly contribute to the authentication of nutraceuticals and drug discovery and validate phytochemicals medicinal characteristics. Overall, OOC models can facilitate a more systematic and efficient assessment of nutraceutical compounds while overcoming the limitations of current traditional in vitro models.

ANGPTL3 Deficiency and Risk of Hepatic Steatosis.

BACKGROUND: ANGPTL3 (angiopoietin-like 3) is a therapeutic target for reducing plasma levels of triglycerides and low-density lipoprotein cholesterol. A recent trial with vupanorsen, an antisense oligonucleotide targeting hepatic production of ANGPTL3, reported a dose-dependent increase in hepatic fat. It is unclear whether this adverse effect is due to an on-target effect of inhibiting hepatic ANGPTL3. METHODS: We recruited participants with ANGPTL3 deficiency related to ANGPTL3 loss-of-function (LoF) mutations, along with wild-type (WT) participants from 2 previously characterized cohorts located in Campodimele, Italy, and St. Louis, MO. Magnetic resonance spectroscopy and magnetic resonance proton density fat fraction were performed to measure hepatic fat fraction and the distribution of extrahepatic fat. To estimate the causal relationship between ANGPTL3 and hepatic fat, we generated a genetic instrument of plasma ANGPTL3 levels as a surrogate for hepatic protein synthesis and performed Mendelian randomization analyses with hepatic fat in the UK Biobank study. RESULTS: We recruited participants with complete (n=6) or partial (n=32) ANGPTL3 deficiency related to ANGPTL3 LoF mutations, as well as WT participants (n=92) without LoF mutations. Participants with ANGPTL3 deficiency exhibited significantly lower total cholesterol (complete deficiency, 78.5 mg/dL; partial deficiency, 172 mg/dL; WT, 188 mg/dL; P<0.05 for both deficiency groups compared with WT), along with plasma triglycerides (complete deficiency, 26 mg/dL; partial deficiency, 79 mg/dL; WT, 88 mg/dL; P<0.05 for both deficiency groups compared with WT) without any significant difference in hepatic fat (complete deficiency, 9.8%; partial deficiency, 10.1%; WT, 9.9%; P>0.05 for both deficiency groups compared with WT) or severity of hepatic steatosis as assessed by magnetic resonance imaging. In addition, ANGPTL3 deficiency did not alter the distribution of extrahepatic fat. Results from Mendelian randomization analyses in 36 703 participants from the UK Biobank demonstrated that genetically determined ANGPTL3 plasma protein levels were causally associated with low-density lipoprotein cholesterol (P=1.7×10-17) and triglycerides (P=3.2×10-18) but not with hepatic fat (P=0.22). CONCLUSIONS: ANGPTL3 deficiency related to LoF mutations in ANGPTL3, as well as genetically determined reduction of plasma ANGPTL3 levels, is not associated with hepatic steatosis. Therapeutic approaches to inhibit ANGPTL3 production in hepatocytes are not necessarily expected to result in the increased risk for hepatic steatosis that was observed with vupanorsen.

Focused Ultrasound, an Emerging Tool for Atherosclerosis Treatment: A Comprehensive Review.

Focused ultrasound (FUS) has emerged as a promising noninvasive therapeutic modality for treating atherosclerotic arterial disease. High-intensity focused ultrasound (HIFU), a noninvasive and precise modality that generates high temperatures at specific target sites within tissues, has shown promising results in reducing plaque burden and improving vascular function. While low-intensity focused ultrasound (LIFU) operates at lower energy levels, promoting mild hyperthermia and stimulating tissue repair processes. This review article provides an overview of the current state of HIFU and LIFU in treating atherosclerosis. It focuses primarily on the therapeutic potential of HIFU due to its higher penetration and ability to achieve atheroma disruption. The review summarizes findings from animal models and human trials, covering the effects of FUS on arterial plaque and arterial wall thrombolysis in carotid, coronary and peripheral arteries. This review also highlights the potential benefits of focused ultrasound, including its noninvasiveness, precise targeting, and real-time monitoring capabilities, making it an attractive approach for the treatment of atherosclerosis and emphasizes the need for further investigations to optimize FUS parameters and advance its clinical application in managing atherosclerotic arterial disease.

Terahertz Optical Properties and Carrier Behaviors of Graphene Oxide Quantum Dot and Reduced Graphene Oxide Quantum Dot via Terahertz Time-Domain Spectroscopy.

Graphene quantum dots (GQDs) with a band gap have been widely applied in many fields owing to their unique optical properties. To better utilize the optical advantages of GQDs, it is important to understand their optical characteristics. Our study demonstrates the optical properties and carrier behaviors of synthesized graphene oxide quantum dot (GOQD) and reduced graphene oxide quantum dot (rGOQD) pellets via Terahertz time-domain spectroscopy (THz-TDS). The complex permittivity and optical conductivity are obtained in the terahertz region, indicating that the optical conductivity of the GOQD is higher than that of the rGOQD. Although rGOQD has a higher carrier density, approximately 1.5-times than that of GOQD, the lower charge carrier mobility of the rGOQD, which is obtained using Drude-Lorentz oscillator model fitting contributes to a decrease in optical conductivity. This lower mobility can be attributed to the more significant number of defect states within the rGOQD compared to GOQD. To the best of our knowledge, our study initially demonstrates the optical property and carrier behaviors of GOQD and rGOQD in the THz region. Moreover, this study provides important information on factors influencing carrier behavior to various fields in which carrier behavior plays an important role.

Highly efficient graphene terahertz modulator with tunable electromagnetically induced transparency-like transmission.

Graphene-based optical modulators have been extensively studied owing to the high mobility and tunable permittivity of graphene. However, weak graphene-light interactions make it difficult to achieve a high modulation depth with low energy consumption. Here, we propose a high-performance graphene-based optical modulator consisting of a photonic crystal structure and a waveguide with graphene that exhibits an electromagnetically-induced-transparency-like (EIT-like) transmission spectrum at terahertz frequency. The high quality-factor guiding mode to generate the EIT-like transmission enhances light-graphene interaction, and the designed modulator achieves a high modulation depth of 98% with a significantly small Fermi level shift of 0.05 eV. The proposed scheme can be utilized in active optical devices that require low power consumption.

Dual antiplatelet Use for extended period taRgeted to AcuTe ischemic stroke with presumed atherosclerotic OrigiN (DURATION) trial: Rationale and design.

RATIONALE: The optimal duration of dual antiplatelet therapy (DAPT) with clopidogrel-aspirin for the large artery atherosclerotic (LAA) stroke subtype has been debated. AIMS: To determine whether the 1-year risk of recurrent vascular events could be reduced by a longer duration of DAPT in patients with the LAA stroke subtype. METHODS AND STUDY DESIGN: A total of 4806 participants will be recruited to detect a statistically significant relative risk reduction of 22% with 80% power and a two-sided alpha error of 0.05, including a 10% loss to follow-up. This is a registry-based, multicenter, prospective, randomized, open-label, blinded end point study designed to evaluate the efficacy and safety of a 12-month duration of DAPT compared with a 3-month duration of DAPT in the LAA stroke subtype. Patients will be randomized (1:1) to either DAPT for 12 months or DAPT for 3 months, followed by monotherapy (either aspirin or clopidogrel) for the remaining 9 months. STUDY OUTCOMES: The primary efficacy outcome of the study is a composite of stroke (ischemic or hemorrhagic), myocardial infarction, and all-cause mortality for 1 year after the index stroke. The secondary efficacy outcomes are (1) stroke, (2) ischemic stroke or transient ischemic attack, (3) hemorrhagic stroke, and (4) all-cause mortality. The primary safety outcome is major bleeding. DISCUSSION: This study will help stroke physicians determine the appropriate duration of dual therapy with clopidogrel-aspirin for patients with the LAA stroke subtype. TRIAL REGISTRATION: URL: https://cris.nih.go.kr/cris. CRIS Registration Number: KCT0004407.

SVEP1 is an endogenous ligand for the orphan receptor PEAR1.

Sushi, von Willebrand factor type A, EGF and pentraxin domain containing 1 (SVEP1) is an extracellular matrix protein that causally promotes vascular disease and associates with platelet reactivity in humans. Here, using a human genomic and proteomic approach, we identify a high affinity, disease-relevant, and potentially targetable interaction between SVEP1 and the orphan receptor Platelet and Endothelial Aggregation Receptor 1 (PEAR1). This interaction promotes PEAR1 phosphorylation and disease associated AKT/mTOR signaling in vascular cells and platelets. Mice lacking SVEP1 have reduced platelet activation, and exogenous SVEP1 induces PEAR1-dependent activation of platelets. SVEP1 and PEAR1 causally and concordantly relate to platelet phenotypes and cardiovascular disease in humans, as determined by Mendelian Randomization. Targeting this receptor-ligand interaction may be a viable therapeutic strategy to treat or prevent cardiovascular and thrombotic disease.

Uncooperative patients suspected of acute stroke ineligible for prehospital stroke screening test by emergency medical service providers: final hospital diagnoses and characteristics.

OBJECTIVE: This study investigated the hospital diagnoses and characteristics of uncooperative prehospital patients suspected of acute stroke who could not undergo a prehospital stroke screening test (PHSST). METHODS: This retrospective observational study was conducted at a single academic hospital with a regional stroke center. We analyzed three scenario-based prehospital stroke screening performances using the final hospital diagnoses: (1) a conservative approach only in patients who underwent the PHSST, (2) a real-world approach that considered all uncooperative patients as screening positive, and (3) a contrapositive approach that all uncooperative patients were considered as negative. RESULTS: Of the 2,836 emergency medical services (EMS)-transported adult patients who met the prehospital criteria for suspicion of acute stroke, 486 (17.1%) were uncooperative, and 570 (20.1%) had a confirmed final diagnosis of acute stroke. The diagnosis in the uncooperative group did not differ from that in the cooperative group (22.0% vs. 19.7%, P=0.246). The diagnostic performances of the PHSST in the conservative approach were as follows: 79.5% sensitivity (95% confidence interval [CI], 75.5%-83.1%), 90.2% specificity (95% CI, 88.8%-91.6%), and 0.849 area under the receiver operating characteristic curve (AUC; 95% CI, 0.829-0.868). The sensitivity and specificity were 83.3% (95% CI, 80.0%-86.3%) and 75.2% (95% CI, 73.3%-76.9%), respectively, in the real-world approach and 64.6% (95% CI, 60.5%-68.5%) and 91.9% (95% CI, 90.7%-93.0%), respectively, in the contrapositive approach. No significant difference was evident in the AUC between the real-world approach and the contrapositive approach (0.792 [95% CI, 0.775-0.810] vs. 0.782 [95% CI, 0.762-0.803], P>0.05). CONCLUSION: We found overestimation (false positive) and underestimation (false negative) in the uncooperative group depending on the scenario-based EMS stroke screening policy for uncooperative prehospital patients suspected of acute stroke.

Multi-millijoule terahertz emission from laser-wakefield-accelerated electrons.

High-power terahertz radiation was observed to be emitted from a gas jet irradiated by 100-terawatt-class laser pulses in the laser-wakefield acceleration of electrons. The emitted terahertz radiation was characterized in terms of its spectrum, polarization, and energy dependence on the accompanying electron bunch energy and charge under various gas target conditions. With a nitrogen target, more than 4 mJ of energy was produced at <10 THz with a laser-to-terahertz conversion efficiency of ~0.15%. Such strong terahertz radiation is hypothesized to be produced from plasma electrons accelerated by the ponderomotive force of the laser and the plasma wakefields on the time scale of the laser pulse duration and plasma period. This model is examined with analytic calculations and particle-in-cell simulations to better understand the generation mechanism of high-energy terahertz radiation in laser-wakefield acceleration.

An unusual case of carotidynia preceding recurrent ischemic stroke with carotid thrombosis in a patient with systemic lupus erythematosus.

Carotid artery thrombosis following carotidynia is an uncommon manifestation of systemic lupus erythematosus. We report the case of a woman without evidence of a lupus flare-up who presented with the unusual clinical course of ipsilateral carotidynia and recurrent ischemic stroke due to carotid thrombosis. To our knowledge, this is the first case of such an unusual manifestation in lupus and highlights distinctive challenges in the diagnosis and management of carotid artery thrombosis following carotidynia.

Impact of Neuroimaging Patterns for the Detection of Atrial Fibrillation by Implantable Loop Recorders in Patients With Embolic Stroke of Undetermined Source.

Objectives: Atrial fibrillation (AF) is a well-known etiology of embolic stroke of undetermined source (ESUS), although the optimal detection strategy of AF was not been fully evaluated yet. We assessed AF detection rate by implantable loop recorder (ILR) in patients with ESUS and compared the clinical characteristics and neuroimaging patterns between the patients with AF and AF-free patients. Methods: We reviewed clinical characteristics and neuroimaging patterns of consecutive patients with who were admitted to our comprehensive stroke center for ESUS and underwent ILR insertion between August 1, 2019, and January 31, 202. The inclusion criteria were (1) 18 years of age or older; (2) classified as having cryptogenic stroke extracted from the group with undetermined stroke according to ESUS International Working Group; and (3) underwent ILR insertion during or after admission due to index ischemic events. Ischemic stroke pattern was classified as (1) tiny-scattered infarction, (2) whole-territorial infarction, (3) lobar infarction and (4) multiple-territorial infarction. Interrogations of data retrieved from the ILR were performed by cardiologists in every month after the implantation. Results: In this study, 41 ESUS patients who received an ILR implantation were enrolled (mean age, 64 years; male sex, 65.9%). The rate of AF detection at 6 months was 34% (14 patients), and the mean time from ILR insertion to AF detection was 52.5 days [interquartile range (IQR), 45.0-69.5]. The median initial NIH stroke scale scores were significantly greater in patients with AF than those without AF (6.5 vs. 3.0, p = 0.019). Whole-territorial infarction pattern was significantly more frequent in patients with AF than in those without AF (64.3% vs.11.1%, p = 0.002). Conclusions: Higher covert AF detection rates within the ESUS patients were most often associated with higher NIHSS and whole-territorial infarction patterns on brain imaging.