Cardioembolic Stroke.

TitleCardioembolic Stroke.
Publication TypeJournal Article
Year of Publication2017
AuthorsKamel H, Healey JS
JournalCirc Res
Date Published2017 Feb 03
KeywordsAnticoagulants, Atrial Fibrillation, Cardiac Surgical Procedures, Clinical Trials as Topic, Heart Diseases, Humans, Myocardial Infarction, Risk Factors, Stroke, Thromboembolism

Cardiac embolism accounts for an increasing proportion of ischemic strokes and might multiply several-fold during the next decades. However, research points to several potential strategies to stem this expected rise in cardioembolic stroke. First, although one-third of strokes are of unclear cause, it is increasingly accepted that many of these cryptogenic strokes arise from a distant embolism rather than in situ cerebrovascular disease, leading to the recent formulation of embolic stroke of undetermined source as a distinct target for investigation. Second, recent clinical trials have indicated that embolic stroke of undetermined source may often stem from subclinical atrial fibrillation, which can be diagnosed with prolonged heart rhythm monitoring. Third, emerging evidence indicates that a thrombogenic atrial substrate can lead to atrial thromboembolism even in the absence of atrial fibrillation. Such an atrial cardiomyopathy may explain many cases of embolic stroke of undetermined source, and oral anticoagulant drugs may prove to reduce stroke risk from atrial cardiomyopathy given its parallels to atrial fibrillation. Non-vitamin K antagonist oral anticoagulant drugs have recently expanded therapeutic options for preventing cardioembolic stroke and are currently being tested for stroke prevention in patients with embolic stroke of undetermined source, including specifically those with atrial cardiomyopathy. Fourth, increasing appreciation of thrombogenic atrial substrate and the common coexistence of cardiac and extracardiac stroke risk factors suggest benefits from global vascular risk factor management in addition to anticoagulation. Finally, improved imaging of ventricular thrombus plus the availability of non-vitamin K antagonist oral anticoagulant drugs may lead to better prevention of stroke from acute myocardial infarction and heart failure.

Alternate JournalCirc. Res.
PubMed ID28154101
PubMed Central IDPMC5312810
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States