Cardioembolic stroke
https://doi.org/10.14412/2074-2711-2015-1-80-86
Abstract
The paper considers the main causes and pathogenetic, clinical, and therapeutic aspects of cardioembolic stroke (CES). The latter is emphasized to be a group of conditions, which is highly heterogeneous in its etiology, pathogenesis, course, and prognosis. Their major risk factors are atrial fibrillation (AF), myocardial infarction (MI), and heart valve apparatus pathology. The leading diagnostic method for CES is brain computed tomography or magnetic resonance imaging, which most commonly visualize a well-defined wedge-shaped area of ischemia on the gray and white matter boundary, as well as cardiological examination. The results of electrocardiography, among them the detection of AF or MI, and echocardiography are of key value for correct diagnosis. Patients with CES are managed by the common principles applied to ischemic stroke. Oral anticoagulants, the efficacy and safety of which have been proven in large clinical trials, are most widely used to prevent recurrent CES. The patients who are at risk for CEA must be followed up by both a cardiologist and a neurologist. Adequate and individualized therapy can substantially reduce the likelihood of cerebrovascular disorders in this category of patients.
About the Authors
I. V. Damulin
Department of Nervous System Diseases and Neurosurgery; 11, Rossolimo St., Moscow 119021
Russian Federation
Russian Federation
D. A. Andreev
Department of Emergency and Preventive Cardiology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia; 6, B. Pirogovskaya St., Build. 1, Moscow 119992
Russian Federation
Russian Federation
Z. K. Salpagarova
Department of Emergency and Preventive Cardiology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia; 6, B. Pirogovskaya St., Build. 1, Moscow 119992
Russian Federation
Russian Federation
References
1. Babikian VL, Caplan LR. Brain embolism is a dynamic process with variable characteristics. Neurology. 2000 Feb 22;54(4):797–801.
2. Ferro JM. Brain embolism. Answers to practical questions. J Neurol. 2003 Feb;250(2):139–47.
3. Ricci S. Embolism from the heart in the young patient: a short review. Neurol Sci. 2003 May;24 Suppl 1:S13–4.
4. Wang D, Liu M, Hao Z, Tao W. Association between reduced kidney function and clinical outcomes after ischaemic stroke with atrial fibrillation. Eur J Neurol. 2014;21(1):160–6. doi: 10.1111/ene.12293. Epub 2013 Nov 15.
5. Суслина ЗА, Пирадов МА, редакторы. Инсульт: диагностика, лечение, профилактика. 2-е издание. Москва: МЕДпресс-информ; 2009. 288 с. [Suslina ZA, Piradov MA, editors. Insul't: diagnostika, lechenie, profilaktika. [Stroke: diagnosis, treatment, prevention]. 2nd edition. Moscow: MEDpressinform; 2009. 288 p.].
6. Широков ЕА. Профилактика инсульта: актуальные проблемы и новые тенденции. Русский медицинский журнал. 2013;(10):466–9. [Shirokov EA. Stroke prevention: current problems and new trends. Russkii meditsinskii zhurnal. 2013;(10):466–9. (In Russ.)].
7. Скворцова ВИ, Евзельман МА. Ишемический инсульт. Орел: Медиа Cфера; 2006. 296 с. [Skvortsova VI, Evzel'man MA. Ishemicheskii insul't [Ischemic stroke]. Orel: Media Cfera; 2006. 296 p.].
8. Inoue T, Kimura K, Minematsu K, Yamaguchi T, for the Japan Multicenter Stroke Investigators’ Collaboration (J-MUSIC). Clinical features of transient ischemic attack associated with atrial fibrillation: analysis of 1084 TIA patients. J Stroke Cerebrovasc Dis. 2004 Jul-Aug;13(4):155–9.
9. Ueno Y, Kimura K, Iguchi Y, et al. Right-toleft shunt and lacunar stroke in patients without hypertension and diabetes. Neurology. 2007 Feb 13;68(7):528–31.
10. Hankey GJ. Stroke. Your Questions Answered. Edinburg: Churchill Livingstone; 2002.
11. Ay H, Koroshetz WJ, Benner T, et al. Neuroanatomic correlates of stroke-related myocardial injury. Neurology. 2006 May 9;66(9):1325–9. Epub 2006 Mar 8.
12. Bogousslavsky J, Cachin C, Regli F, et al. Cardiac sources of embolism and cerebral infarction – clinical consequences and vascular concomitants. Neurology. 1991 Jun;41(6):855–9.
13. Wolf PA, Dawber TR, Thomas HE, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978 Oct;28(10):973–7.
14. Wright IS, Foley WT. Use of anticoagulants in the treatment of heart disease. Am J Med. 1947 Dec;3(6):718–39.
15. Stratton JR, Resnick AD. Increased embolic risk in patients with left ventricular thrombi. Circulation. 1987 May;75(5):1004–11.
16. Ciaccheri M, Castelli G, Cecchi F, et al. Lack of correlation between intracavitary thrombosis detected by cross sectional echocardiography and systemic emboli in patients with dilated cardiomyopathy. Br Heart J. 1989 Jul;62(1):26–9.
17. Levine HJ, Pauker SG, Salzman EW. Antithrombotic therapy in valvular heart disease. Chest. 1989 Feb;95(2 Suppl):98S–106S.
18. Морозова ТЕ, Андрущишина ТБ. Профилактика тромбоэмболических осложнений у пациентов с фибрилляцией предсердий. Фарматека. 2014;9(282):81–7. [Morozova TE, Andrushchishina TB. Prevention of thromboembolism in patients with atrial fibrillation. Farmateka. 2014;9(282):81–7. (In Russ.)].
19. Ашихмин ЯИ, Щекочихин ДЮ. Индивидуализированная антитромботическая терапия при фибрилляции предсердий. Фарматека. 2013;18(271):119–23. [Ashikhmin YaI, Shchekochikhin DYu. Individualized antithrombotic therapy in atrial fibrillation. Farmateka. 2013;18(271):119–23. (In Russ.)].
20. Явелов ИС, редактор. Диагностика и лечение фибрилляции предсердий. Рекомендации РКО, ВНОА и АССХ, выпуск 2. Москва; 2012. 100 с. [Yavelov IS, editor. Diagnostika i lechenie fibrillyatsii predserdii. Rekomendatsii RKO, VNOA i ASSKh, vypusk 2 [Diagnosis and treatment of atrial fibrillation. Recommendations of RCS, RSAS and CVSA, 2nd issue]. Moscow; 2012. 100 p.].
21. Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 с. [Parfenov VA, Khasanova DR. Ishemicheskii insul't [Ischemic stroke]. Moscow: MIA; 2012. 288 p.].
22. Парфенов ВА, Вербицкая СВ. Вторичная профилактика инсульта при фибрилляции предсердий, применение апиксабана (исследования ARISTOTLE, AVERROES). Неврология, нейропсихиатрия, психосоматика. 2014; (спецвыпуск 2. Инсульт):7–14. [Parfenov VA, Verbitskaya SV. Secondary prevention of stroke in atrial fibrillation, use of apixaban: ARISTOTLE, AVERROES studies. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;(2s):7–14. (In Russ.)]. doi: http://dx.doi.org/10.14412/2074-27112014-2S-7-14
23. Connolly S, Ezekowitz M, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009 Sep 17;361(12):1139–51. doi: 10.1056/NEJMoa0905561. Epub 2009 Aug 30.
24. Eikelboom J, Weitz J. Dabigatran and risk of myocardial infarction. Nat Rev Cardiol. 2012 Mar 13;9(5):260–2. doi: 10.1038/nrcardio.2012.34.
25. Connolly S, Eikelboom J, Joyner C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011 Mar 3;364(9):806–17. doi: 10.1056/NEJMoa1007432. Epub 2011 Feb 10.
26. Granger C, Alexander J, McMurray J, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011 Sep 15;365(11):981–92. doi: 10.1056/NEJMoa1107039. Epub 2011 Aug 27.
27. Patel M, Mahaffey K, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011 Sep 8;365(10):883–91. doi: 10.1056/NEJMoa1009638. Epub 2011 Aug 10.
28. Diener HC, Connolly J, Ezekowitz M, et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial. Lancet Neurol. 2010 Dec;9(12):1157–63. doi: 10.1016/S14744422(10)70274-X. Epub 2010 Nov 6.
29. Easton J, Lopes R, Bahit M, et al. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of the ARISTOTLE trial. Lancet Neurol. 2012 Jun;11(6):503–11. doi: 10.1016/S14744422(12)70092-3. Epub 2012 May 8.
Review
For citations:
Damulin I.V., Andreev D.A., Salpagarova Z.K. Cardioembolic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2015;7(1):80-86. (In Russ.) https://doi.org/10.14412/2074-2711-2015-1-80-86
Views: 2577
Email this article 