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Cardioembolism

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https://www.readbyqxmd.com/read/29766772/rivaroxaban-for-stroke-prevention-after-embolic-stroke-of-undetermined-source
#1
Robert G Hart, Mukul Sharma, Hardi Mundl, Scott E Kasner, Shrikant I Bangdiwala, Scott D Berkowitz, Balakumar Swaminathan, Pablo Lavados, Yongjun Wang, Yilong Wang, Antonio Davalos, Nikolay Shamalov, Robert Mikulik, Luis Cunha, Arne Lindgren, Antonio Arauz, Wilfried Lang, Anna Czlonkowska, Jens Eckstein, Rubens J Gagliardi, Pierre Amarenco, Sebastian F Ameriso, Turgut Tatlisumak, Roland Veltkamp, Graeme J Hankey, Danilo Toni, Daniel Bereczki, Shinichiro Uchiyama, George Ntaios, Byung-Woo Yoon, Raf Brouns, Matthias Endres, Keith W Muir, Natan Bornstein, Serefnur Ozturk, Martin J O'Donnell, Matthys M De Vries Basson, Guillaume Pare, Calin Pater, Bodo Kirsch, Patrick Sheridan, Gary Peters, Jeffrey I Weitz, W Frank Peacock, Ashkan Shoamanesh, Oscar R Benavente, Campbell Joyner, Ellison Themeles, Stuart J Connolly
Background Embolic strokes of undetermined source represent 20% of ischemic strokes and are associated with a high rate of recurrence. Anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, may result in a lower risk of recurrent stroke than aspirin. Methods We compared the efficacy and safety of rivaroxaban (at a daily dose of 15 mg) with aspirin (at a daily dose of 100 mg) for the prevention of recurrent stroke in patients with recent ischemic stroke that was presumed to be from cerebral embolism but without arterial stenosis, lacune, or an identified cardioembolic source...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29766771/five-year-risk-of-stroke-after-tia-or-minor-ischemic-stroke
#2
Pierre Amarenco, Philippa C Lavallée, Linsay Monteiro Tavares, Julien Labreuche, Gregory W Albers, Halim Abboud, Sabrina Anticoli, Heinrich Audebert, Natan M Bornstein, Louis R Caplan, Manuel Correia, Geoffrey A Donnan, José M Ferro, Fernando Gongora-Rivera, Wolfgang Heide, Michael G Hennerici, Peter J Kelly, Michal Král, Hsiu-Fen Lin, Carlos Molina, Jong Moo Park, Francisco Purroy, Peter M Rothwell, Tomas Segura, David Školoudík, P Gabriel Steg, Pierre-Jean Touboul, Shinichiro Uchiyama, Éric Vicaut, Yongjun Wang, Lawrence K S Wong
Background After a transient ischemic attack (TIA) or minor stroke, the long-term risk of stroke and other vascular events is not well known. In this follow-up to a report on 1-year outcomes from a registry of TIA clinics in 21 countries that enrolled 4789 patients with a TIA or minor ischemic stroke from 2009 through 2011, we examined the 5-year risk of stroke and vascular events. Methods We evaluated patients who had had a TIA or minor stroke within 7 days before enrollment in the registry. Among 61 sites that participated in the 1-year outcome study, we selected 42 sites that had follow-up data on more than 50% of their enrolled patients at 5 years...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29764671/stroke-type-and-severity-in-patients-with-subclinical-atrial-fibrillation-an-analysis-from-the-asymptomatic-atrial-fibrillation-and-stroke-evaluation-in-pacemaker-patients-and-the-atrial-fibrillation-reduction-atrial-pacing-trial-assert
#3
Kanjana S Perera, Mukul Sharma, Stuart J Connolly, Jia Wang, Michael R Gold, Stefan H Hohnloser, Chu Pak Lau, Isabelle C Van Gelder, Carlos Morillo, Alessandro Capucci, Carsten W Israel, Gluca Botto, Jeffery S Healey
BACKGROUND: The Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT) demonstrated that subclinical atrial fibrillation (SCAF) was associated with a 2.5-fold increased risk of stroke. However, the absolute stroke rate was only 1.7% per year and fewer than 20% patients with stroke had SCAF in the preceding 30 days. This raises the possibility that SCAF is merely a risk marker for stroke rather than the cause...
April 18, 2018: American Heart Journal
https://www.readbyqxmd.com/read/29749592/-a-systematic-review-of-the-characteristics-and-prognosis-of-subjects-who-suffer-an-embolic-stroke-of-undetermined-source
#4
J Molina-Seguin, A B Vena, L Colas-Campas, I Benalbdelhak, F Purroy
INTRODUCTION: The concept of embolic stroke of undetermined source (ESUS) has recently appeared to better characterise patients with cryptogenic stroke. PATIENTS AND METHODS: A systematic review of studies published since 2014 was performed to evaluate the epidemiology, clinical features and prognosis of patients with ESUS and their proportion among patients with cryptogenic stroke. RESULTS: Ten studies were identified with a total of 14,810 patients...
May 16, 2018: Revista de Neurologia
https://www.readbyqxmd.com/read/29725167/the-role-of-clinical-variables-and-vkorc1-polymorphism-in-efficacy-and-stability-of-acenocoumarol-in-neurological-patients
#5
Surendra Kumar, Ashish Kant Dubey, Jayantee Kalita, Usha Kant Misra
Objective: To analyze the clinical importance of VKORC1 polymorphism and its correlation with stability of oral anticoagulation. Patients and Methods: In a hospital-based study, the patients on oral anticoagulant (OAC) were included during 2013-2016. The patients received OAC for cardioembolic stroke, cerebral venous sinus thrombosis (CVST), and prevention of deep vein thrombosis (DVT). Demographic, clinical, and neurological findings were recorded. Stability of anticoagulation was determined by percentage of time international normalized ratio (INR) values were in therapeutic range...
April 2018: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/29703777/prehospital-neurological-deterioration-in-stroke
#6
Sabreena J Slavin, Heidi Sucharew, Kathleen Alwell, Charles J Moomaw, Daniel Woo, Opeolu Adeoye, Matthew L Flaherty, Simona Ferioli, Jason McMullan, Jason Mackey, Felipe De Los Rios La Rosa, Sharyl Martini, Brett M Kissela, Dawn O Kleindorfer
BACKGROUND AND PURPOSE: Patients with stroke can experience neurological deterioration in the prehospital setting. We evaluated patients with stroke to determine factors associated with prehospital neurological deterioration (PND). METHODS: Among the Greater Cincinnati/Northern Kentucky region (population ~1.3 million), we screened all 15 local hospitals' admissions from 2010 for acute stroke and included patients aged ≥20. The GCS was compared between emergency medical services (EMS) arrival and hospital arrival, with decrease ≥2 points considered PND...
April 27, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29699899/acute-renal-infarction-a-diagnostic-challenge
#7
Danny Markabawi, Harvir Singh-Gambhir
Acute renal infarction is a relatively rare and scarcely reported condition. Contrast enhanced CT scan is essential for diagnosing this condition. The most common etiology of this condition is cardioembolic, however up to 59% of cases could be classified as idiopathic acute renal infarction. Here we present a case of a 41 year-old male who was admitted for acute onset right flank pain with fevers and rigors. A CT abdomen with contrast showed findings concerning for right pyelonephritis or renal infarction...
April 19, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29691787/the-role-of-circle-of-willis-anatomy-variations-in-cardio-embolic-stroke-a-patient-specific-simulation-based-study
#8
Debanjan Mukherjee, Neel D Jani, Jared Narvid, Shawn C Shadden
We describe a patient-specific simulation based investigation on the role of Circle of Willis anatomy in cardioembolic stroke. Our simulation framework consists of medical image-driven modeling of patient anatomy including the Circle, 3D blood flow simulation through patient vasculature, embolus transport modeling using a discrete particle dynamics technique, and a sampling based approach to incorporate parametric variations. A total of 24 (four patients and six Circle anatomies including the complete Circle) models were considered, with cardiogenic emboli of varying sizes and compositions released virtually and tracked to compute distribution to the brain...
April 24, 2018: Annals of Biomedical Engineering
https://www.readbyqxmd.com/read/29661647/which-ischemic-stroke-subtype-is-associated-with-hyperhomocysteinemia
#9
Levent Gungor, Murat Polat, Mehlika Berra Ozberk, Bahattin Avci, Ummet Abur
BACKGROUND: Stroke is still a major global health problem in both developed and developing countries. Defining stroke subtype and underlying etiologies is a major step to choose the best method for prophylaxis. Homocysteine is an endothelial toxin and elevated levels have been associated with stroke risk. In this study, we hypothesized that serum total homocysteine level may be related with specific atherothrombotic ischemic stroke subtypes and aimed to find if high serum homocysteine levels are correlated with any specific ischemic stroke subtype...
April 13, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29629263/a-biatrial-myxoma-with-triple-ripples
#10
Ramachandra Barik
Cardiac myxoma is a benign tumor, but it is known for its space-occupying effect at the site of origin and frequent systemic embolization. This case report highlights a biatrial myxoma of interatrial septum who presented with significant tricuspid valve regurgitation, atrial fibrillation, and cardioembolic stroke of the left parietal lobe, i.e., a biatrial myxoma with triple ripples.
January 2018: Journal of Cardiovascular Echography
https://www.readbyqxmd.com/read/29628339/ischemic-stroke-secondary-to-paradoxical-embolism-through-a-pulmonary-arteriovenous-malformation-case-report-and-review-of-the-literature
#11
Ryan Cappa, Jeanette Du, Joseph F Carrera, Jimmy V Berthaud, Andrew M Southerland
Paradoxical embolism due to isolated pulmonary arteriovenous malformation (AVM) is an uncommon cause of ischemic stroke, with the majority occurring in patients who have not yet been diagnosed with their malformation. We report a 32-year-old man who presented with an abrupt onset of right facial weakness and expressive aphasia. Brain magnetic resonance imaging revealed an acute infarct in the left middle cerebral artery territory and chronic infarcts in the bilateral cerebellar hemispheres. A cardioembolic mechanism was initially considered in the setting of perimyocarditis diagnosed a few months earlier...
April 5, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29627170/spontaneous-micro-aggregation-of-platelets-predicts-clinical-outcome-in-acute-ischemic-stroke
#12
Risa Kudoh, Kasumi Mikami, Maiko Kitajima, Keiko Aizu, Yui Kitajima, Joji Hagii, Hirofumi Metoki, Satoshi Seino, Yoshiko Baba, Minoru Yasujima, Tomohiro Osanai
BACKGROUNDS: Spontaneous micro-aggregation of platelets (SMAP) is frequently observed in stroke patients and is a trigger for the additional development of larger thrombi. We tested the hypothesis that SMAP may predict clinical outcome in acute ischemic stroke patients. METHODS AND RESULTS: Consecutive acute ischemic stroke patients (n = 358) who were transferred to our hospital within 24 hours after its onset were enrolled. Peripheral venous blood was sampled to measure various parameters when they arrived...
April 4, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29618553/stroke-among-young-west-africans-evidence-from-the-siren-stroke-investigative-research-and-educational-network-large-multisite-case-control-study
#13
Fred Stephen Sarfo, Bruce Ovbiagele, Mulugeta Gebregziabher, Kolawole Wahab, Rufus Akinyemi, Albert Akpalu, Onoja Akpa, Reginald Obiako, Lukman Owolabi, Carolyn Jenkins, Mayowa Owolabi
BACKGROUND AND PURPOSE: Stroke in lower and middle-income countries affects a young and productive age group. Data on factors associated with stroke in the young are sorely lacking from lower and middle-income countries. Our objective is to characterize the nature of stroke and its risk factors among young West Africans aged <50 years old. METHODS: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Nigeria and Ghana...
April 4, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29617449/assessment-of-veins-in-t2-weighted-mr-angiography-predicts-infarct-growth-in-hyperacute-ischemic-stroke
#14
Susumu Yamaguchi, Nobutaka Horie, Minoru Morikawa, Yohei Tateishi, Takeshi Hiu, Yoichi Morofuji, Tsuyoshi Izumo, Kentaro Hayashi, Takayuki Matsuo
BACKGROUND AND PURPOSE: T2*-weighted magnetic resonance angiography (SWAN) detects hemodynamic insufficiency as hypointense areas in medullary or cortical veins. We therefore investigated whether SWAN can help predict ischemic penumbra-like lesions in patients with acute ischemic stroke (AIS). MATERIALS AND METHODS: Magnetic resonance imaging (MRI) records-including SWAN, diffusion-weighted imaging (DWI), and magnetic resonance angiography (MRA)-of consecutive patients with major vessel occlusion within 6 h from AIS onset were analyzed...
2018: PloS One
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
#15
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/29608495/medical-management-of-rheumatic-heart-disease-a-systematic-review-of-the-evidence
#16
E Anne Russell, Warren F Walsh, Ben Costello, Alex Ja McLellan, Alex Brown, Christopher M Reid, Lavinia Tran, Graeme P Maguire
Rheumatic heart disease (RHD) is an important cause of heart disease globally. Its management can encompass medical and procedural (catheter and surgical) interventions. Literature pertaining to the medical management of RHD from PubMed 1990-2016 and via selected article reference lists was reviewed. Areas included symptom management, left ventricular (LV) dysfunction, rate control in mitral stenosis (MS), atrial fibrillation (AF), anticoagulation, infective endocarditis prophylaxis and management in pregnancy...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29607895/seasonal-variations-in-neurological-severity-and-outcomes-of-ischemic-stroke-5-year-single-center-observational-study
#17
Kazunori Toyoda, Masatoshi Koga, Hiroshi Yamagami, Chiaki Yokota, Shoichiro Sato, Manabu Inoue, Tomotaka Tanaka, Kaoru Endo, Jun Fujinami, Masafumi Ihara, Kazuyuki Nagatsuka, Kazuo Minematsu
BACKGROUND: Seasonal variations in the severity and outcomes of stroke remain unclarified.Methods and Results:A total of 2,965 acute ischemic stroke patients from a single-center prospective registry were studied. Among the total patients, stroke onset did not vary by season, though it varied with a peak in winter when limited to patients >75 years old (P=0.026), when limited to patients with moderate-to-severe initial neurological deficits (National Institutes of Health Stroke Scale Score ≥10, P=0...
March 31, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/29607570/incidence-and-etiology-of-microinfarcts-in-patients-with-ischemic-stroke
#18
Jamary Oliveira-Filho, Hakan Ay, Ashkan Shoamanesh, Kwang Yeol Park, Ross Avery, Mine Sorgun, Gyeong-Moon Kim, Pedro T Cougo, Steven M Greenberg, M Edip Gurol
BACKGROUND AND PURPOSE: Cerebral microinfarcts (CMI) are associated with intracerebral hemorrhage due to small vessel disease (SVD) in studies not including an ischemic etiologic workup. We aimed to determine their incidence and potential causes in a large ischemic stroke (IS) cohort. METHODS: Consecutive patients with MRI-confirmed IS within 72 hours of onset were enrolled. Subjects had either single high-risk embolic source (cardioembolic or large vessel disease) or no embolic source...
April 1, 2018: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/29606886/influence-of-abcb1-and-cyp3a5-gene-polymorphisms-on-pharmacokinetics-of-apixaban-in-patients-with-atrial-fibrillation-and-acute-stroke
#19
Alexander Valerevich Kryukov, Dmitry Alekseevich Sychev, Denis Anatolevich Andreev, Kristina Anatolievna Ryzhikova, Elena Anatolievna Grishina, Anastasia Vladislavovna Ryabova, Mark Alekseevich Loskutnikov, Valeriy Valerevich Smirnov, Olga Dmitrievna Konova, Irina Andreevna Matsneva, Pavel Olegovich Bochkov
Introduction: Difficulties in non-vitamin K anticoagulant (NOAC) administration in acute stroke can be associated with changes in pharmacokinetic parameters of NOAC such as biotransformation, distribution, and excretion. Therefore, obtaining data on pharmacokinetics of NOAC and factors that affect it may help develop algorithms for personalized use of this drug class in patients with acute cardioembolic stroke. Patients and methods: Pharmacokinetics of apixaban in patients with acute stroke was studied earlier by Kryukov et al...
2018: Pharmacogenomics and Personalized Medicine
https://www.readbyqxmd.com/read/29600887/prognosis-of-dolichoectasia-in-non-cardioembolic-transient-ischemic-attack-and-minor-stroke
#20
Xinmiao Zhang, Jing Jing, Xingquan Zhao, Liping Liu, Xia Meng, Anxin Wang, Yuesong Pan, David Wang, Yilong Wang, Yongjun Wang
Objectives This study aimed to estimate the prognosis of dolichoectasia in non-cardioembolic transient ischemic attack (TIA) and minor stroke patients. Methods Data were derived from the imaging subgroup of patients in the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. Dolichoectasia was defined as ectasia (basilar artery diameter >4.5 mm) and dolichosis (either basilar artery bifurcation above the suprasellar cistern or lateral to the margin of the clivus or dorsum sellae)...
March 30, 2018: Neurological Research
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