The paradoxical embolism phenomenon in patients with embolic cryptogenic stroke

Mekhryakov, S. A.; Кулеш, А. А.; Pokalenko, E. A.; Syromyatnikova, L. I.; Kulikova, Sofya; Дробаха, В. Е.; Shestakov, V. V.; Karakulova, Yu. V.

doi:10.14412/2074-2711-2020-1-13-21

Cited by 6 publications

(2 citation statements)

References 41 publications

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“…Этиология каждого третьего ишемического инсульта остается неизвестной, что ограничивает эффективность вторичной профилактики [1,2]. Тогда как в молодом возрасте основной причиной криптогенного инсульта (КИ) служат открытое овальное окно и диссекция стенки артерии [3][4][5][6], в пожилом в качестве таковой, как правило, выступает скрытая фибрилляция предсердий (ФП) [7,8]. Несмотря на то что ФП длительное время рассматривалась в качестве непосредственной причины тромбообразования и кардиоэмболии, известно, что лишь у малой доли больных пароксизм ФП по времени совпадает с инсультом или транзиторной ишемической атакой [9].…”

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Biomarkers of atrial cardiopathy in patients with different pathogenetic subtypes of ischemic stroke

Mekhryakov

Кулеш

Syromyatnikova

et al. 2020

RJTAO

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Studies of the biomarkers of atrial cardiopathy seem to be promising for identifying patients with cryptogenic stroke (CS), in which an intensive search for atrial fibrillation is indicated. Nevertheless, the diagnostic value of these markers and their threshold values require clarification.Objective: to present the characteristics of echocardiographic markers for atrial cardiopathy and the serum concentration of N-terminal pro-Btype natriuretic peptide (NT-proBNP) in embolic CS versus cardioembolic stroke (CES) and non-cardioembolic stroke (non-CES) to determine the threshold values of parameters with the highest sensitivity and specificity in differentiating CES and non-CES.Patients and methods. A total of 259 patients with ischemic stroke were examined. The standard examination additionally involved calculation of the parameters that reflected left atrial LA) function (LAF): LA emptying fraction (LAEF), and LA functional index (LAFI). The serum NT-proBNP concentration was also determined in 75 patients.Results and discussion. The patients with CES versus those with CS and non-CES were characterized by a considerable increase in LA diameter (4.3 [3.5; 4.5] cm vs 3.7 [3.4; 4.0] cm vs 3.7 [3.4; 3.9] cm; p=0.005 and p=0.009, respectively), LAVI (35.7 [30.5; 39.9] ml/m2 vs 28.5 [25.6; 34.6] ml/m2 vs 27.1 [24.5; 31.2] ml/m2 ; p< 0.001) and NT-proBNP level (559 [409; 1144] pg/ml vs 164 [65; 308] pg/ml vs 191 [63; 446] pg/ml; p=0.002 and p=0.019, respectively), as well as by a lower LAEF value [50.3 [48.5; 51.1]% vs 54.7 [51.6; 56.6]% vs 54.9 [52.5; 56.8]%; p< 0.001). The only parameter that showed significant differences between all the three groups (CES, CS, and nonCES) was LAFI (0.24 [0.2; 0.32] units vs 0.37 [0.3; 0.47] units vs 0.40 [0.34; 0.47] units; p<0.00 1), while maintaining the differences in the values for the two groups (CS and non-CES) (p=0.004). The following threshold values of biomarkers were obtained for CES and nonCES; these were a LA diameter of 41.5 mm (p< 0.001), a LAVI of 36.3 ml/m2 (p< 0.001), a LAEF of 51.8% (p< 0.001), a LAFI of 0.28 units (p< 0.001), and an NT-proBNP of 316 pg/ml (p< 0.001). Analysis of the ROC curves and the area under the curve (AUC) revealed that the most informative criteria for sensitivity and specificity were LAEF (79 and 88%, AUC 0.89), NT-proBNP (67 and 91%, AUC 0.89) and LAFI (93 and 72%, AUC 0.81).Conclusion. The CS group and non-CES one are comparable in the echocardiographic manifestations of atrial cardiopathy and in serum NTproBNP values. LAEF and NT-proBNP concentrations are promising biomarkers to classify CS patients into potential arterio- and cardioembolic types.

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Biomarkers of atrial cardiopathy in patients with different pathogenetic subtypes of ischemic stroke

Mekhryakov

Кулеш

Syromyatnikova

et al. 2020

RJTAO

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“…В 20-34% случаев происходит неполное смыкание перегородок и между предсердиями остается постоянное или персистирующее сообщение [8]. Тромбы, которые образуются в венозной системе, могут проходить через ООО в левые отделы сердца, становясь причиной окклюзии артерий большого круга кровообращения; такая эмболия называется парадоксальной [9]. В последние годы было проведено значительное количество исследований, посвященных изучению эффективности эндоваскулярного закрытия ООО для вторичной профилактики ИИ и определению категории пациентов, у которых вмешательство будет наиболее оправданным.…”

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Safety and efficacy of endovascular patent foramen ovale closure: the first results of a Russian multicenter study

Ognerubov

Терещенко

Samko

et al. 2020

RJTAO

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Patent foramen ovale (PFO) is detectable in more than 25% of the adult population and is generally clinically insignificant. However, it can be a cause of paradoxical embolism in some cases. Randomized trials indicate that endovascular PFO closure in patients with a history of cryptogenic stroke is an effective method for the secondary prevention of catastrophic brain damage.Objective: to study the safety and efficiency of endovascular PFO closure in young patients with a history of cryptogenic stroke.Patients and methods. Sixty-two patients, including (22 males and 40 females) women, underwent percutaneous PFO closure in May 2018 to March 2020. The patients' mean age was 37.4±7.6 years. The inclusion criteria were a prior cryptogenic ischemic stroke lasting less than 12 months and PFO with a high risk for paradoxical embolism (PFO concurrent with atrial septal aneurysm or hypermobility; PFO, ≥2 mm size; the presence of the Chiari network and/or the Eustachian valve).Results and discussion. The technical success of the operation was achieved in all cases. In 50 (80.6%) patients, the right chamber of the heart was completely isolated from the left one in the first 3 months. During the first year, the atria were also completely isolated in 10 (16.1%) patients. A left-to-right shunt persisted in 2 (3.2%) patents 12 months later. Two patients were found to have main procedural complications: one had perioperative atrial fibrillation and the other had pseudoaneurysm formation at the puncture site.Conclusion. Endovascular PFO closure is a safe and effective operation for the secondary prevention of recurrent ischemic stroke. In our study, blood shunting through the PFO was stopped in 96.6% of patients at less than 6 months after surgery, which suggests that there is a rapid and effective reduction in the risk of paradoxical embolism.

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Ischemic stroke associated with patent foramen ovale: hospital database analysis

Белопасова¹,

Кулеш²,

Mekhryakov³

et al. 2023

Z. nevrol. psikhiatr. im. S.S. Korsakova

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The paradoxical embolism phenomenon in patients with embolic cryptogenic stroke

Cited by 6 publications

References 41 publications

Biomarkers of atrial cardiopathy in patients with different pathogenetic subtypes of ischemic stroke

Biomarkers of atrial cardiopathy in patients with different pathogenetic subtypes of ischemic stroke

Safety and efficacy of endovascular patent foramen ovale closure: the first results of a Russian multicenter study

Ischemic stroke associated with patent foramen ovale: hospital database analysis

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