The role of echocardiography in patients after ischemic stroke

Hutyra, Martin; Pavlů, Luděk; Šaňák, Daniel; Přeček, Jan; Köcher, Martin; Tüdös, Zbyněk; Škála, Tomáš; Moravec, Ondřej; Vindiš, David; Táborský, Miloš

doi:10.1016/j.crvasa.2016.02.003

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Another group that can also benefit from an echocardiographic examination is young patients with a cryptogenic stroke. In these patients, the detection of a patent persistent foramen ovale (PFO) with a documented right-left leak may be an indication for percutaneous closure to avoid recurrent AIS episodes [6][7][8]29]. The transthoracic examination allows a certain diagnosis of PFO only in a minority of cases.…”

Section: Other Resultsmentioning

confidence: 99%

Transthoracic echocardiography in the assessment of cardiogenic causes of ischaemic stroke

Król

Żarek

Wilk

et al. 2019

Neurol Neurochir Pol.

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Introduction. One of the leading causes of death in Poland is stroke. Cardiogenic stroke is known to be one of the most important reasons for acute ischaemic stroke (AIS), comprising 25-30% of all AISs. Aim of study.Assessment of the prevalence of different risk factors of cardiogenic causes of AIS using transthoracic echocardiography (TTE) Material and methods. Transthoracic echocardiograms performed in patients with AIS admitted to a single neurological ward between October 2013 and September 2017 were analysed. Patients were assigned, based on the results of their TTE and their previous medical history of atrial fibrillation (AF), to one of three groups depending on the level of the risk of occurrence of cardiogenic causes of AIS. Ethical permission. According to Dz.U.2001, no. 126, 1381 no ethical permission was needed.Results. 663 patients with AIS were included in the study. Patients with high risk of cardiogenic cause of AIS: 26.7% (N = 177 patients [p]). Of these, 64.4% (114 p) were diagnosed with AF. 31.6% (56 p) with sinus rhythm during hospitalisation had a history of paroxysmal AF (PAF). In 11.9% (21 p) of the patients qualified to the high risk group, factors other than AF were found. Patients with moderate risk of cardiogenic cause of AIS: 10.1% (67 p). Patients with low risk of cardiogenic cause of AIS: 25.9% (172 p). Echocardiographic results led to a change in therapy in 1.21% of cases.Conclusions. 1. Transthoracic echocardiography performed routinely in all AIS patients affects the treatment in a very low percentage of cases. 2. The group that could benefit the most from TTE examination includes people without established indications for chronic anticoagulant therapy, in particular patients after myocardial infarction and people with additional clinical symptoms. 3. In patients with AIS, the diagnostic sensitivity of TTE in the detection of PFO is low. Young people with a cryptogenic ischaemic stroke should undergo a transoesophageal assessment.

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Section: Other Resultsmentioning

confidence: 99%

Transthoracic echocardiography in the assessment of cardiogenic causes of ischaemic stroke

Król

Żarek

Wilk

et al. 2019

Neurol Neurochir Pol.

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“…It is unclear if echocardiography should be recommended for patients with cryptogenic stroke. 110 Echocardiography may be beneficial for certain patients, yet unnecessary for others. 111 In younger patients or those with a suspected paraneoplastic syndrome, a search for hypercoagulable states might be undertaken.…”

Section: Cryptogenic Strokementioning

confidence: 99%

Emergency management of stroke in the era of mechanical thrombectomy

Brandler

Baksh

2019

Clin Exp Emerg Med

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Emergency management of stroke has been directed at the delivery of recombinant tissue plasminogen activator (tPA) in a timely fashion. Because of the many limitations attached to the delivery of tPA and the perceived benefits accrued to tPA, its use has been limited. Mechanical thrombectomy, a far superior therapy for the largest and most disabling strokes, large vessel occlusions (LVOs), has changed the way acute strokes are managed. Aside from the rush to deliver tPA, there is now a need to identify LVO and refer those patients with LVO to physicians and facilities capable of delivering urgent thrombectomy. Other parts of emergency department management of stroke are directed at identifying and mitigating risk factors for future strokes and at preventing further damage from occurring. We review here the most recent literature supporting these advances in stroke care and present a framework for understanding the role that emergency physicians play in acute stroke care.

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