Diagnosis and Management of Cardioembolic Stroke

Abstract

OBJECTIVECardioembolic stroke accounts for nearly 30% of ischemic strokes. Prompt diagnosis of the underlying mechanism may improve secondary prevention strategies. This article reviews recent randomized trials, observational studies, case reports, and guidelines on the diagnosis and treatment of cardioembolic stroke.LATEST DEVELOPMENTSSeveral pathologies can lead to cardioembolic stroke, including atrial fibrillation, aortic arch atheroma, patent foramen ovale, left ventricular dysfunction, and many others. Secondary stroke prevention strategies differ across these heterogeneous mechanisms. In addition to medical treatment advances such as the use of direct oral anticoagulants in patients with atrial fibrillation, surgical treatments such as closure of patent foramen ovale have been shown to reduce the risk of recurrent stroke in select patients. Furthermore, left atrial appendage occlusion is a promising strategy for patients with atrial fibrillation who are candidates for short-term oral anticoagulation therapy but not long-term oral anticoagulation therapy.ESSENTIAL POINTSA thorough diagnostic evaluation is essential to determine cardioembolic causes of stroke. In addition to risk factor management and lifestyle modifications, identification and targeting of the underlying cardioembolic stroke mechanisms will lead to improved stroke prevention strategies in patients with cardioembolic stroke.

Acute Cardioembolic Stroke in the Setting of Subtherapeutic Anticoagulation

“…The goal of the workup of cardioembolic stroke is to detect the presence of a potential intracardiac source of the embolism. Our patient had atrial fibrillation, an arrhythmia that increases the risk of stroke by fivefold, and one of the most common causes of cardioembolic strokes [ 1 ]. Warfarin has been shown to mitigate the risk of stroke in such patients and is superior to aspirin [ 7 ]; thus, our patient was on the appropriate therapy.…”

“…Cardioembolic strokes are embolic strokes that can be traced to cardiovascular pathology, such as atrial fibrillation, left ventricular thrombi, cardiac tumors, valvular vegetations, and paradoxical emboli [ 1 ]. Cardioembolic strokes account for up to 1/4 of all ischemic strokes and are caused by various cardiovascular pathologies.…”

Update of Anticoagulation Use in Cardioembolic Stroke With a Special Reference to Endovascular Treatment

“…Concomitant stroke mechanisms such as cancer-related hypercoagulability, small vessel disease, and large artery atherosclerosis predicted stroke recurrence in the IAC study [ 28 ]. Therefore, it should be emphasized that an effective secondary prevention strategy post-AIS in AF patients may extend beyond AC, especially for those already on AC [ 29 ].…”