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Cryptogenic stroke

B Sunil Abhishek, Anupam Bhambhani
Ischaemic stroke is among the leading causes of disability and death. Despite extensive vascular, cardiac and serological evaluations, the cause remains unknown in 20%-40% of patients. These are classified as cryptogenic stroke. Paradoxical embolism is one of the many causes of cryptogenic stroke. The term paradoxical embolism is used to describe an embolus of venous origin entering the systemic circulation through a patent foramen ovale (PFO), atrial septal defect (ASD), ventricular septal defect or extracardiac communication such as pulmonary arteriovenous malformation...
September 2017: National Medical Journal of India
Sreekanth Vemulapalli, Manesh R Patel
No abstract text is available yet for this article.
June 17, 2018: Journal of the American Heart Association
Guillaume Turc, David Calvet, Patrice Guérin, Marjorie Sroussi, Gilles Chatellier, Jean-Louis Mas
BACKGROUND: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing patent foramen ovale (PFO) closure, anticoagulation, and antiplatelet therapy to prevent stroke recurrence in patients with PFO-associated cryptogenic stroke. METHODS AND RESULTS: We searched Medline, Cochrane Library, and EMBASE through March 2018. The primary outcome was stroke recurrence. Pooled incidences, hazard ratios, and risk ratios (RRs) were calculated in random-effects meta-analyses...
June 17, 2018: Journal of the American Heart Association
Markus Reinthaler, Ann-Kathrin Ozga, David Sinning, Jonathan Curio, Haitham S Al-Hindwan, Johan Bäckemo Johansson, Friedrich Jung, Andreas Lendlein, Geraldine Rauch, Ulf Landmesser
BACKGROUND: Transcatheter foramen ovale closure (TPC) has emerged as a potential treatment option for patients with cryptogenic strokes and persistent foramen ovale (PFO). However, previous randomized controlled trials could hardly demonstrate any benefit compared to medical treatment (Med-Tx). Recently new data have become available which may change current practice of transcatheter PFO closure. METHODS: A systematic review and meta-analysis comparing TPC and Med-Tx based on all available multicentric randomized controlled trials was performed...
July 2018: American Heart Journal
Ufuk Emre, Taskin Gunes, Irem Pinar, Furuzan Kokturk, Esengul Liman, Orhan Yağiz
Background and purpose: In cancer patients, an ischemic stroke can be seen as both a direct effect of cancer and a complication of treatment. This condition can negatively affect the follow-up and treatment of these patients. For this research, we aimed to evaluate the clinical features, stroke types and etiological features of ischemic stroke patients with histories of cancer or found to have cancer during the aetiological investigation. Methods: We retrospectively evaluated 100 patients (57 males, 43 females) who were hospitalized with acute stroke and determined to have the presence of cancer or a cancer history during the aetiological investigation between 2011 and 2016...
May 30, 2018: Ideggyógyászati Szemle
Péter Böjti, Noémi Eszter Bartha, Zsolt May, Dániel Bereczki, Szilvia Fülöp, Zoltán Szakács, Géza Szilágyi
Background and purpose: After routine workup, 23-25% of ischemic strokes etiology remains unknown, i.e. cryptogenic. However, according to international results pathogenic patent foramen ovale (PFO) reveals in 25% of these cases. Aim of our retrospective study to prove the substantial etiological role of PFO-related stroke (PFO-RS) in cryptogenic strokes (CS), and to identify age related differences in stroke etiology. Methods: All new ischemic strokes of 2014-2015 were classified by ASCOD (Atherosclerosis, Small-vessel disease, Cardiac pathology, Other, Dissection) phenotyping...
May 30, 2018: Ideggyógyászati Szemle
Alain Fraisse, Giovanni di Salvo, John C Janssen, Sonya V Babu-Narayan, Michael A Gatzoulis
No abstract text is available yet for this article.
September 1, 2018: International Journal of Cardiology
Vincenzo Pasceri, Francesco Pelliccia, Edoardo Bressi, Ludmilla Mantione, Carlo Gaudio, Giulio Speciale, Roxana Mehran, George D Dangas, Giuseppe Patti
BACKGROUND: Controlled randomized trials (CRTs) comparing the efficacy of patent foramen ovale (PFO) closure and medical therapy in patients with cryptogenic stroke have yielded heterogeneous results. No data are available on the net clinical benefit with the two strategies. METHODS: We pooled data of 3440 patients enrolled in five CRTs, randomized to PFO closure (n = 1829) or medical therapy (n = 1611) and followed for a mean of 4.1 years. RESULTS: The net composite endpoint of stroke, major bleeding or atrial fibrillation (AF)/flutter was not different among PFO closure and medical therapy (OR 1...
September 1, 2018: International Journal of Cardiology
Maurizio Acampa, Pietro Enea Lazzerini, Francesca Guideri, Rossana Tassi, Andrea Lo Monaco, Giuseppe Martini
BACKGROUND: About one third of ischaemic strokes are classified as embolic strokes of undetermined source (ESUS). A silent atrial fibrillation (AF) may play a pathogenic role in these strokes and P wave dispersion (PWD), representing an electrocardiographic (ECG) predictor for paroxysmal AF, thereby a potential marker of covert cardioembolism, was found to be increased in cryptogenic stroke. Furthermore, current evidence links AF to inflammation: inflammatory markers, such as high-sensitive C-reactive protein (hsCRP), have been related to the development and persistence of AF, possibly by promoting atrial remodelling...
May 8, 2018: Heart, Lung & Circulation
David Thaler
No abstract text is available yet for this article.
June 6, 2018: Lancet Neurology
Sara Mazzucco, Linxin Li, Lucy Binney, Peter M Rothwell
BACKGROUND: Percutaneous closure of patent foramen ovale (PFO) has been shown to be superior to medical treatment alone for prevention of recurrent stroke after cryptogenic transient ischaemic attack or non-disabling stroke in patients aged 60 years or younger. The justification for trials in older patients with transient ischaemic attack or stroke depends on whether PFO is shown to be associated with cryptogenic events at older ages, for which existing evidence is conflicting, and on the population burden of PFO-associated events...
June 6, 2018: Lancet Neurology
Mehmet Akif Topcuoglu, Liping Liu, Dong-Eog Kim, M Edip Gurol
Cardiac embolism continues to be a leading etiology of ischemic strokes worldwide. Although pathologies that result in cardioembolism have not changed over the past decade, there have been significant advances in the treatment and stroke prevention methods for these conditions. Atrial fibrillation remains the prototypical cause of cardioembolic strokes. The availability of new long-term monitoring devices for atrial fibrillation detection such as insertable cardiac monitors has allowed accurate detection of this leading cause of cardioembolism...
May 2018: Journal of Stroke
Georgios Tsivgoulis, Apostolos Safouris, Dong-Eog Kim, Andrei V Alexandrov
Atherosclerosis is a major cause of ischemic stroke that can be effectively prevented with appropriate lifestyle modifications and control of cardiovascular risk factors. Medical advances in recent years along with aggressive cardiovascular risk factor modifications have resulted in decreased recurrence rates of atherosclerotic stroke. Non-statin lipid-lowering molecules have recently shown clinical benefit and are recommended for very high-risk patients to reduce their risk of stroke. Aggressive hypertension treatment is crucial to reduce atherosclerotic stroke risk...
May 2018: Journal of Stroke
Ashish H Shah, Mark Osten, Lee Benson, Sami Alnasser, Yvonne Bach, Rohan Vishwanath, Alex Van De Bruaene, Healey Shulman, Jeneka Navaranjan, Rafique Khan, Eric Horlick
OBJECTIVES: The aim of this study was to assess the incidence of persistently positive results on agitated saline contrast injection after patent foramen ovale (PFO) closure, the underlying mechanism, and management. BACKGROUND: Transcatheter intervention to close a PFO is reasonable in highly selected patients younger than 60 years, after a thorough cardioneurological investigation following a cryptogenic stroke, particularly in the presence of thromboembolic disease or in patients at high risk for venous thrombosis...
June 11, 2018: JACC. Cardiovascular Interventions
Hamidreza Saber, Mohan Palla, Shaghayegh Kazemlou, Mahmoud R Azarpazhooh, Navid Seraji-Bozorgzad, Réza Behrouz
OBJECTIVE: To compare the outcomes of patent foramen ovale (PFO) closure vs antiplatelet agent (APA) vs oral anticoagulation therapy (OAT) for secondary prevention of stroke in patients with cryptogenic stroke, using direct and indirect evidence from existing randomized data. METHODS: Relevant randomized controlled trials were identified by a systematic review. The efficacy outcome was stroke recurrence, and safety outcomes were atrial fibrillation and bleeding complications at the end of follow-up...
June 6, 2018: Neurology
Georgios Tsivgoulis, Aristeidis H Katsanos, Dimitris Mavridis, Alexandra Frogoudaki, Agathi-Rosa Vrettou, Ignatios Ikonomidis, John Parissis, Spyridon Deftereos, Theodore Karapanayiotides, Lina Palaiodimou, Angeliki Filippatou, Fabienne Perren, Georgios Hadjigeorgiou, Anne W Alexandrov, Panayiotis D Mitsias, Andrei V Alexandrov
OBJECTIVE: Current guidelines report no benefit for patent foramen ovale (PFO) closure compared to medical treatment in patients with cryptogenic ischemic stroke (IS) or TIA. Two recent randomized controlled clinical trials have challenged these recommendations. METHODS: We performed a systematic review and network meta-analysis of randomized controlled trials to estimate the safety and efficacy of closure compared to medical treatment, and to compare available devices...
June 6, 2018: Neurology
Dominik M Wiktor, John D Carroll
Controversy has persisted for over a decade whether transcatheter patent foramen ovale (PFO) closure reduces the rate of recurrent ischemic stroke for patients who have had a cryptogenic ischemic stroke and have a PFO. In September 2017, 3 positive randomized trials: RESPECT long-term (Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment trial), REDUCE (GORE® HELEX® Septal Occluder / GORE® CARDIOFORM Septal Occluder and Antiplatelet Medical Management for Reduction of Recurrent Stroke or Imaging-Confirmed TIA in Patients With Patent Foramen Ovale [PFO]), and CLOSE (Patent Foramen Ovale Closure or Anticoagulants Versus Antiplatelet Therapy to Prevent Stroke Recurrence) were published...
March 2018: Circulation. Cardiovascular Interventions
Mette Sørensen Resen, Mai Bang Poulsen, Karsten Overgaard, Rune Skovgaard Rasmussen, Anne Merete Boas Soja, Brian Nilsson, Mariana Obreja Kristensen, Christina Kruuse, Peter Sommer Ulriksen
Objective Transoesophageal echocardiography (TEE) is the gold standard for the detection of cardiac emboli sources in ischaemic stroke patients, but new computed tomography (CT) scanners are able to visualize the heart. This pilot study aimed to compare findings on TEE with combined cardiovascular scan and cerebral CT angiography in cryptogenic ischaemic stroke patients. Methods This pilot study enrolled patients with cryptogenic ischaemic stroke who underwent a combined cardiovascular and cerebral CT angiography scan and a TEE examination, which were interpreted in a blinded manner...
January 1, 2018: Journal of International Medical Research
Lohit Garg, Affan Haleem, Shweta Varade, Keithan Sivakumar, Mahek Shah, Brijesh Patel, Manyoo Agarwal, Sahil Agrawal, Megan Leary, Bryan Kluck
BACKGROUND: The clinical benefit of patent foramen ovale (PFO) closure after cryptogenic stroke has been a topic of debate for decades. Recently, 3 randomized controlled trials of PFO closure in patients with cryptogenic stroke demonstrated a significantly reduced risk of recurrent stroke compared with standard medical therapy alone. This meta-analysis was performed to clarify the efficacy of PFO closure for future stroke prevention in this population. METHODS: A systematic literature search was undertaken...
May 24, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
X Q Li, P Yuan, W J Ma, G Z Liu
Objective: To investigate the pathogenesis of young and middle-aged stroke patients with patent foramen ovale (PFO) by analyzing clinical characteristics. Methods: Data of 298 consecutive young and middle-aged patients diagnosed as stroke were retrospectively collected from Department of Neurology, Beijing Anzhen Hospital from January 2010 to January 2017.Patients were divided into cryptogenic stroke (CS) group and not-CS group.Risk factors, characteristics of PFO and infarct of imaging were analyzed between two groups...
May 22, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
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