Cardioembolic Stroke
The best way to prevent cardioembolic stroke remains early detection and treatment of AF - WD Freeman
image by: Atrial Fibrillation Association - US
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Cardioembolic stroke: everything has changed
The diagnosis of cardioembolic stroke has two sides to the coin: on the negative side, there is the absence of evidence of another cause of stroke. On the positive side, there is evidence of a cardioembolic stroke such as a Holter recording showing intermittent atrial fibrillation, an echocardiogram showing a cardioembolic source such as thrombus in the left atrium, a ventricular aneurysm, ventricular dyskinesia or cardiomyopathy.
An additional important consideration is the clinical pattern of cerebral involvement: a patient with cortical ischaemia in multiple vascular territories should be regarded as having a cardioembolic (or aortic atheromatous) source. For example, if a right-handed…
Resources
Why we should avoid Warfarin to prevent stroke in atrial fibrillation
Warfarin's efficacy in preventing embolic events in patients with atrial fibrillation (AF) has been proven and its mechanism understood (3,4). However, apart from patient's risk of bleeding when using it, Warfarin has several shortcomings...
Classification of Cardiogenic Stroke - Overcoming the Challenges
Cardiogenic stroke represents a major part with approximately one-third of all ischaemic strokes, but evaluation is not as simple as could be expected.
Detection of occult atrial fibrillation in patients with embolic stroke of uncertain source: a work in progress
Atrial fibrillation accounts for a substantial proportion of ischemic strokes of known etiology and may be responsible for an additional subset of the 25–40% of strokes of unknown cause (so-called cryptogenic). Oral anticoagulation is significantly more effective than antiplatelet therapy in the secondary prevention of atrial fibrillation-related strokes, providing justification for developing more sensitive approaches to detecting occult paroxysms of atrial fibrillation.
Embolic Stroke, Atrial Fibrillation, and Microbleeds
Should the patient be started on oral anticoagulation or aspirin? if oral anticoagulation, which agent (warfarin, dabigatran, apixaban, others)?
Prevention of cardioembolic stroke
The best way to prevent cardioembolic stroke remains early detection and treatment of AF, and treating the underlying stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating cardioembolic stroke.
Prevention Strategies for Cardioembolic Stroke: Present and Future Perspectives
One of the main challenges of the future years will be to understand competitiveness between old and new preventive strategies.
Stroke of Cardioembolic Origin: What We Have Learnt in the Past 10 Years?
Cardioembolic cerebral infarction accounts for 18-25% of all cerebral infarctions and is the ischemic stroke subtype most commonly found in very old patients (>85 years of age). Cardioembolic stroke is a severe condition due to the large size of the infarction, with a high in-hospital mortality rate (6-27%) and significant neurological dysfunction; also, the risk of spontaneous infarct recurrence ranges between 1% and 10%.
TAVR Embolic Protection Systems to Reduce Stroke Rates
While transcatheter aortic valve replacement (TAVR) is a paradigm shift in how valve disease is treated, one nagging safety issue that remains is TAVR’s stroke rate, which is higher than traditional surgical valve replacements.
Cardioembolic stroke: everything has changed
Historically, because of the difficulty of using warfarin safely and effectively, many patients with cardioembolic stroke who should have been anticoagulated were instead given ineffective antiplatelet therapy (or no antithrombotic therapy). With the arrival of new oral anticoagulants that are not significantly more likely than aspirin to cause severe haemorrhage, everything has changed.
Cardiology Clinics
Review of some of the controversies involving this not uncommon disorder.
Continuum
Cardioembolic stroke is common and disproportionately more disabling than nonembolic mechanisms of stroke. Its incidence is expected to rise because of the age-related incidence of atrial fibrillation and an aging population.
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