Cardioembolic stroke: classification of causes and prevention strategies
Abstract
This literature review covers the diversity of cardioembolic stroke (CES), the heterogeneity of the embolism sources and the morphological characteristics of the embolic substrate. It is emphasized that the determination of the individual tactics of secondary prevention is based on the verification of specific cardiac causes of stroke, for convenience, stratified as pathology of chambers, heart valves and variants of paradoxical embolism (PE). It has been shown that the leading pathology of the heart chambers associated with CES is nonvalvular atrial fibrillation and left ventricular thrombosis, and the main basis for the prevention of stroke in this pathology is oral anticoagulant therapy with direct oral anticoagulants or vitamin K antagonists (warfarin). The main types of heart valve pathology are prosthetic valves and rheumatic mitral stenosis. In this case, oral anticoagulant therapy also serves as the basis for secondary prevention. In the absence of the need to prescribe anticoagulants (mainly in the pathology of natural heart valves) acetylsalicylic acid is the drug of choice. In infective endocarditis (IE), the basic prevention strategies are antibiotic therapy and surgery. Surgical tactics also remain the main one for the prevention of CES in tumors of the left heart. Transcatheter closure of the patent foramen ovale and occlusion of the left atrial appendage are being introduced into the daily practice of interventional medicine in order to prevent ischemic stroke. A balanced individual approach to the patient, a targeted cardiological examination, a comprehensive analysis of clinical and instrumental data and the reasonable use of funds that have proven their effectiveness and safety in the main strategies for stroke prevention, are essential in effective prevention of CES.
About the Authors
A. V. Fonyakin
Research Center of Neurology
Russian Federation
Russian Federation
Laboratory of Cardioneurology, Second Neurological Department
80, Volokolamskoe Shosse, Moscow 125367, Russia
L. A. Geraskina
Research Center of Neurology
Russian Federation
Russian Federation
Laboratory of Cardioneurology, Second Neurological Department
80, Volokolamskoe Shosse, Moscow 125367, Russia
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Fonyakin A.V., Geraskina L.A. Cardioembolic stroke: classification of causes and prevention strategies. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(6):4-13. (In Russ.) https://doi.org/10.14412/2074-2711-2021-6-4-13
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