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Cryptogenic stroke

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https://www.readbyqxmd.com/read/29678635/high-incidence-of-occult-atrial-fibrillation-in-asian-patients-with-cryptogenic-stroke
#1
Swee-Chong Seow, Ann-Kee How, Siew-Pang Chan, Hock-Luen Teoh, Toon-Wei Lim, Devinder Singh, Wee-Tiong Yeo, Pipin Kojodjojo
BACKGROUND: Occult atrial fibrillation (AF) is not uncommon in patients with stroke. In western cohorts, insertable loop recorders (ILRs) have been shown to be the gold-standard and are cost-effective for AF detection. Anticoagulation for secondary stroke prevention is indicated if AF is detected. The incidence of occult AF among Asian patients with cryptogenic stroke is unclear. METHODS: Patients with cryptogenic stroke referred between August 2014 and February 2017 had ILRs implanted...
April 17, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29677250/review-in-cryptogenic-stroke-with-pfo-adding-pfo-closure-to-medical-therapy-reduces-recurrence
#2
Nabeel M Syed, Wieslaw Oczkowski
No abstract text is available yet for this article.
April 17, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29649819/patent-foramen-ovale-and-cryptogenic-stroke-or-transient-ischemic-attack-to-close-or-not-to-close-a-systematic-review-and-meta-analysis
#3
Simona Lattanzi, Francesco Brigo, Claudia Cagnetti, Mario Di Napoli, Mauro Silvestrini
BACKGROUND: The optimal strategy of secondary stroke prevention in patients with patent foramen ovale (PFO) is controversial. This study was performed to evaluate the efficacy and safety of the device closure (DC) versus the medical therapy (MT) in patients with cryptogenic stroke or transient ischemic attack (TIA) and PFO. SUMMARY: Randomized controlled trials with active and control groups receiving the DC plus MT and MT alone in patients with history of cryptogenic stroke/TIA and diagnosis of PFO were systematically searched...
April 12, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29644412/patent-foramen-ovale-closure-versus-medical-therapy-for-prevention-of-recurrent-cryptogenic-embolism-updated-meta-analysis-of-randomized-clinical-trials
#4
Brunilda Alushi, Alexander Lauten, Salvatore Cassese, Roisin Colleran, Stefanie Schüpke, Himanshu Rai, Heribert Schunkert, Bernhard Meier, Ulf Landmesser, Adnan Kastrati
BACKGROUND: We performed an updated meta-analysis of all randomized-controlled trials (RCTs) comparing patent foramen ovale (PFO) closure with medical therapy for prevention of recurrent ischemic stroke. METHODS AND RESULTS: We searched Medline, EMBASE, and Cochrane databases, and proceedings of international meetings for RCTs of patients with cryptogenic stroke and PFO comparing percutaneous PFO closure versus medical therapy for prevention of recurrent ischemic stroke...
April 11, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29622180/roles-of-transesophageal-echocardiography-and-cardiac-computed-tomography-for-evaluation-of-left-atrial-thrombus-and-associated-pathology-a-review-and-critical-analysis
#5
REVIEW
Faraz Pathan, Harvey Hecht, Jagat Narula, Thomas H Marwick
Evaluation of the left atrium and left atrial appendage for the presence of thrombus prior to cardioversion and pulmonary vein isolation, and of the entire heart for embolic sources in the setting of cryptogenic stroke, has long been standard medical care. Guidelines have uniformly recommended transesophageal echocardiography (TEE) to accomplish these goals. In recent years, computed tomographic angiography has demonstrated diagnostic accuracy similar to that of TEE for the detection of thrombus. Analysis of the pertinent data and relative merits of the 2 technologies leads to the conclusions that: 1) both modalities have some unique, nonoverlapping capabilities that may dictate their use in specific situations; 2) computed tomographic angiography is a reasonable alternative to TEE when the primary aim is to exclude left atrial and left atrial appendage thrombus and in patients in whom the risks associated with TEE outweigh the benefits; and 3) both options should be discussed with the patient in the setting of shared decision making...
April 2018: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29617507/closure-of-patent-foramen-ovale-versus-medical-therapy-after-cryptogenic-stroke-meta-analysis-of-five-randomized-controlled-trials-with-3440-patients
#6
Michel Pompeu Barros Oliveira Sá, Luiz de Albuquerque Pereira de Oliveira Neto, Gabriella Caroline Sales do Nascimento, Erik Everton da Silva Vieira, Gabriel Lopes Martins, Karine Coelho Rodrigues, Giulia Cioffi Nascimento, Alexandre Motta de Menezes, Ricardo Felipe de Albuquerque Lins, Frederico Pires Vasconcelos Silva, Ricardo Carvalho Lima
OBJECTIVE: We aimed to determine whether patent foramen ovale closure reduces the risk of stroke, also assessing some safety outcomes. INTRODUCTION: The clinical benefit of closing a patent foramen ovale after a cryptogenic stroke has been an open question for several decades, so that it is necessary to review the current state of published medical data in this regard. METHODS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LI-LACS, Google Scholar and reference lists of relevant articles were searched for randomized controlled trials that reported any of the following outcomes: stroke, death, major bleeding or atrial fibrillation...
January 2018: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29615448/a-protocol-for-a-prospective-observational-study-using-chest-and-thumb-ecg-transient-ecg-assessment-in-stroke-evaluation-tease-in-sweden
#7
Peter Magnusson, Hirsh Koyi, Gustav Mattsson
INTRODUCTION: Atrial fibrillation (AF) causes ischaemic stroke and based on risk factor evaluation warrants anticoagulation therapy. In stroke survivors, AF is typically detected with short-term ECG monitoring in the stroke unit. Prolonged continuous ECG monitoring requires substantial resources while insertable cardiac monitors are invasive and costly. Chest and thumb ECG could provide an alternative for AF detection poststroke.The primary objective of our study is to assess the incidence of newly diagnosed AF during 28 days of chest and thumb ECG monitoring in cryptogenic stroke...
April 3, 2018: BMJ Open
https://www.readbyqxmd.com/read/29609876/covert-atrial-fibrillation-and-atrial-high-rate-episodes-as-a-potential-cause-of-embolic-strokes-of-undetermined-source-their-detection-and-possible-management-strategy
#8
REVIEW
Hirofumi Tomita, Shingo Sasaki, Joji Hagii, Norifumi Metoki
Cryptogenic ischemic stroke, defined as stroke of undetermined etiology, accounts for 7-25% of all ischemic strokes. Stroke severity is reported to be less severe than cardioembolic stroke and similar to large-artery atherosclerosis. Because its etiology is believed to be mostly an embolic type, it is often called "embolic strokes of undetermined source" (ESUS). In patients with ESUS, it is of significant importance to seek an embolic source with intensive diagnostic assessment, which mostly originates from the heart...
March 30, 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29602754/patent-foramen-ovale-closure-versus-medical-therapy-for-cryptogenic-stroke-meta-analysis-of-randomised-trials
#9
Tom Kai Ming Wang, Michael Tzu Min Wang, Peter Ruygrok
BACKGROUND: Patent foramen ovale (PFO) is a common anatomic variant associated with cryptogenic stroke. Percutaneous PFO closure in these patients to prevent recurrent neurological events has been controversial for decades, and mixed results have been reported from past and recent observational and randomised studies. This meta-analysis of randomised trials aims to compare the efficacy and safety of PFO closure with medical therapy for cryptogenic stroke patients. METHODS: Medline, PubMed, EMBASE, Scopus and Cochrane were searched from January 1980 to September 2017 by two authors independently to include original randomised trials comparing PFO closure with medical therapy for secondary stroke prevention...
March 12, 2018: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29602258/patent-foramen-ovale-pfo-closure-versus-medical-therapy-for-prevention-of-recurrent-stroke-in-patients-with-prior-cryptogenic-stroke-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#10
Anthony K Akobeng, Ibtihal Abdelgadir, Younes Boudjemline, Ziyad M Hijazi
OBJECTIVES: We performed a systematic review and meta-analysis of randomized controlled trials to assess the effect of closure of a patent foramen ovale (PFO) compared with medical therapy for the prevention of stroke in patients with prior cryptogenic stroke. BACKGROUND: The role of PFO closure in reducing risk of stroke in patients with prior cryptogenic stroke has been controversial. METHODS: We searched PubMed, Embase, CINAHL, and CENTRAL for randomized trials investigating PFO closure versus medical therapy...
March 30, 2018: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29597192/transcatheter-closure-of-patent-foramen-ovale-versus-medical-therapy-after-cryptogenic-stroke-a-meta-analysis-of-randomized-controlled-trials
#11
Fahed Darmoch, Yasser Al-Khadra, Mohamad Soud, Zaher Fanari, M Chadi Alraies
BACKGROUND: Patent foramen ovale (PFO) with atrial septal aneurysm is suggested as an important potential source for cryptogenic strokes. Percutaneous PFO closure to reduce the recurrence of stroke compared to medical therapy has been intensely debated. The aim of this study is to assess whether PFO closure in patients with cryptogenic stroke is safe and effective compared with medical therapy. METHOD: A search of PubMed, Medline, and Cochrane Central Register from January 2000 through September 2017 for randomized controlled trails (RCT), which compared PFO closure to medical therapy in patients with cryptogenic stroke was conducted...
March 29, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29595639/an-overlooked-cause-in-a-patient-with-recurrent-ischemic-stroke-a-case-report
#12
Xunzhe Yang, Mingsheng Liu, Yicheng Zhu, Xiaobo Zhang, Shan Gao, Jun Ni
RATIONALE: The majority of ischemic strokes are due to cardioembolism, large vessel atherothromboembolism, small vessel occlusive disease, or other unusual mechanisms. In most clinical settings, many strokes without a well-defined etiology requires a thorough diagnostic evaluation, otherwise the underlying cause might be easily overlooked. Here we report on the rare cause of a patient with recurrent stroke. PATIENT CONCERNS: A 50-year-old female patient had a 4-year history of recurrent acute onset of neurological deficits...
March 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29590333/patent-foramen-ovale-closure-vs-medical-therapy-for-cryptogenic-stroke-a-meta-analysis-of-randomized-controlled-trials
#13
Yousif Ahmad, James P Howard, Ahran Arnold, Matthew Shun Shin, Christopher Cook, Ricardo Petraco, Ozan Demir, Luke Williams, Juan F Iglesias, Nilesh Sutaria, Iqbal Malik, Justin Davies, Jamil Mayet, Darrel Francis, Sayan Sen
Aims: The efficacy of patent foramen ovale (PFO) closure for cryptogenic stroke has been controversial. We undertook a meta-analysis of randomized controlled trials (RCTs) comparing device closure with medical therapy to prevent recurrent stroke for patients with PFO. Methods and results: We systematically identified all RCTs comparing device closure to medical therapy for cryptogenic stroke in patients with PFO. The primary efficacy endpoint was recurrent stroke, analysed on an intention-to-treat basis...
March 24, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29576519/percutaneous-closure-of-patent-foramen-ovale-vs-medical-treatment-for-patients-with-history-of-cryptogenic-stroke-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#14
Leonidas Palaiodimos, Damianos G Kokkinidis, Robert T Faillace, T Raymond Foley, George D Dangas, Matthew J Price, Ioannis Mastoris
BACKGROUND: Patients with history of cryptogenic stroke are more likely to have a patent foramen ovale (PFO) and should be managed with antithrombotic agents, while the alternative option is percutaneous closure of PFOs. Our aim was to perform a meta-analysis of randomized controlled trials (RCTs) comparing percutaneous closure vs. medical treatment for patients with PFO and prior cryptogenic stroke. METHODS: Medline, Scopus and Cochrane databases were reviewed...
March 2, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29573928/left-sided-atrial-septal-pouch-is-a-risk-factor-for-cryptogenic-stroke
#15
Mateusz K Hołda, Agata Krawczyk-Ożóg, Mateusz Koziej, Danuta Sorysz, Jakub Hołda, Dariusz Dudek, Wiesława Klimek-Piotrowska
BACKGROUND: The atrial septal pouch is an anatomic variant of the interatrial septum. The morphology of the left-sided septal pouch (LSSP) may favor blood stasis and predispose to thromboembolic events. The aim of this study was to determine the association between LSSP presence and cryptogenic stroke. METHODS: A total of 126 consecutive patients with cryptogenic stroke and 137 age-matched control patients without stroke were analyzed retrospectively. The presence and dimensions of LSSPs were assessed using transesophageal echocardiography...
March 21, 2018: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/29570476/patent-foramen-ovale-and-hypoxemia
#16
Mohammad K Mojadidi, Juan C Ruiz, Jason Chertoff, Muhammad O Zaman, Islam Y Elgendy, Ahmed N Mahmoud, Mohammad Al-Ani, Akram Y Elgendy, Nimesh K Patel, Ghanshyam Shantha, Jonathan M Tobis, Bernhard Meier
Patent foramen ovale (PFO), an embryonic remnant of the fetal circulation, is present in 20-25% of adults. While recent observational studies and clinical trials have established the link between PFO-mediated right-to-left shunting with cryptogenic stroke and migraine with aura, the role of a PFO in exacerbating hypoxemic medical conditions (i.e., sleep apnea, chronic obstructive pulmonary disease, pulmonary hypertension, platypnea-orthodeoxia, pulmonary arteriovenous malformation, high altitude pulmonary edema, and exercise desaturation) remains poorly evaluated...
March 22, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29569253/detection-and-management-of-atrial-fibrillation-after-cryptogenic-stroke-or-embolic-stroke-of-undetermined-source
#17
REVIEW
Tommaso Sanna, Paul D Ziegler, Filippo Crea
Cryptogenic stroke (CS) and embolic stroke of unknown source (ESUS) represent a major challenge to healthcare systems worldwide. Atrial fibrillation (AF) is commonly found after CS or ESUS. Independent of the mechanism of the index CS or ESUS, detection of AF in these patients offers the opportunity to reduce the risk of stroke recurrence by prescribing an anticoagulant instead of aspirin. The detection of AF may be pursued with different monitoring strategies. Comparison of monitoring strategies should take into account that AF detection rates reported in published studies, and then pooled in meta-analyses, are not only a function of the monitoring strategy itself, but also depend on patient-related, device-related, and study design-related factors...
March 22, 2018: Clinical Cardiology
https://www.readbyqxmd.com/read/29564942/cost-effectiveness-of-percutaneous-patent-foramen-ovale-closure-as-secondary-stroke-prevention
#18
David L Tirschwell, Mark Turner, David Thaler, James Choulerton, David Marks, John Carroll, Lee MacDonald, Richard W Smalling, Maria Koullick, Ning Yan Gu, Jeffrey L Saver
OBJECTIVE: Compared to medical therapy alone, percutaneous closure of patent foramen ovale (PFO) further reduces risk of recurrent ischemic strokes in carefully selected young to middle-aged patients with a recent cryptogenic ischemic stroke. The objective of this study was to evaluate the cost-effectiveness of this therapy in the context of the United Kingdom (UK) healthcare system. METHODS: A Markov cohort model consisting of 4 health states (Stable after index stroke, Post-Minor Recurrent Stroke, Post-Moderate Recurrent Stroke, and Death) was developed to simulate the economic outcomes of device-based PFO closure compared to medical therapy...
March 22, 2018: Journal of Medical Economics
https://www.readbyqxmd.com/read/29558659/cancer-associated-ischemic-stroke-a-retrospective-multicentre-cohort-study
#19
Stefano Grazioli, Maurizio Paciaroni, Giancarlo Agnelli, Monica Acciarresi, Andrea Alberti, Cataldo D'Amore, Valeria Caso, Michele Venti, Luigina Guasti, Walter Ageno, Alessandro Squizzato
BACKGROUND: The association between stroke and cancer is well-known but insufficiently investigated. Aim of this multicentre retrospective cohort study was to estimate the prevalence of cancer-associated ischemic stroke, describe clinical outcomes in patients with cancer-associated ischemic stroke and investigate independent factors associated with active cancer. METHODS: Consecutive adult patients admitted for acute ischemic stroke were included. Included patients were admitted in the Stroke Unit of the Hospital of Perugia, Italy, from March 2005 to March 2015, and in a medical unit of the Hospital of Varese, Italy, from January 2010 till December 2011...
March 15, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29556872/embolic-strokes-of-undetermined-source-in-a-cohort-of-polish-stroke-patients
#20
Jan Pawel Bembenek, Michal Adam Karlinski, Iwona Kurkowska-Jastrzebska, Anna Czlonkowska
We aimed to provide a descriptive analysis of embolic stroke of undetermined etiology (ESUS) population based on a long-term prospective stroke registry. We retrospectively analyzed data collected in a detailed registry regarding consecutive patients admitted for first-ever ischemic stroke (IS) between January 2001 and December 2015. We used Org 10172 in Acute Stroke Treatment classification supplemented with ESUS criteria proposed by the Cryptogenic Stroke/ESUS International Working Group. Within the ESUS group, we additionally compared patients ≤ 60 and > 60 years of age...
March 19, 2018: Neurological Sciences
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