Acute cardioembolic stroke: an update

Abstract

Cardioembolic infarction is the most severe ischemic stroke subtype, but some clinical characteristics of the disease are still poorly defined. An update of relevant aspects related to clinical manifestations, biological characteristics, prognostic implications and treatment is presented in this article. Topics discussed include epidemiology and risk factors, clinical features and prognosis, cardiac work-up studies, patent foramen ovale, complex atheromatosis of the aortic arch, blood biomarkers, heart failure, and thrombolytic and anti-thrombotic therapy. Cardioembolic infarction is an important topic at the frontier between cardiology and vascular neurology, occurs frequently in daily practice, has a high impact for patients, healthcare systems and society, and merits an updated review of current clinical issues, advances and controversies.

Trends in clinical features and early outcome in patients with acute cardioembolic stroke subtype over a 19-year period

“…[26] The vascular topography involving the territory of distribution of the middle cerebral artery was significantly more frequently found in patients with cardioembolic infarction than in those with noncardioembolic stroke (68% vs. 46.6%); this coincides with the greater volume of cerebral infarctions mainly affecting the cerebral hemispheres. [1,2,24,27] In agreement with other studies, [5,12,28] our results show that the short-term prognosis of patients with cardioembolic cerebral infarction is poor in comparison with other subtypes of cerebral infarction, with higher in-hospital mortality (21.9% vs. 8.2%) and a lower percentage of symptom-free patients at discharge from the hospital (14.3% vs. 19.9%).…”

Smoking–Thrombolysis Relationship Depends on Ischemic Stroke Subtype

“…This could be explained by the poor prognosis after IVT in patients with cardioembolism stroke caused by its larger and tightly organized thrombus, large infarct, high NIHSS score at presentation, often hemorrhagic transformation, and lack of time to establish effective collateral circulation. [14][15][16][17][18][19] When these factors were taken into account, the interaction between smoking and thrombolysis was not present. However, in SAO and other subgroups, we also did not find a statistical difference in SICH and mortality between smokers and nonsmokers, because of small patient numbers and low event rate, these results should therefore be interpreted with caution.…”

Spontaneous Neurological Deterioration in Acute Cardioembolic Stroke: A Subgroup of Patients With Early Severe Prognosis

“…Cardioembolic stroke is a subtype of cerebral infarction in which maximal neurological defi cit usually occurs suddenly at the onset of stroke in contrast to atherothrombotic stroke, lacunar infarction or infarction of unknown cause where neurological defi cit generally progresses over the fi rst hours after stroke onset [2,21]. In the present series, END was observed in 8.3% of patients.…”