Umemura Takeru, Nishizawa Shigeru, Nakano Yoshiteru, Saito Takeshi, Kitagawa Takehiro, Miyaoka Ryo, Suzuki Kohei, Yamamoto Junkoh
Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
J Stroke Cerebrovasc Dis. 2019 Jul;28(7):1810-1815. doi: 10.1016/j.jstrokecerebrovasdis.2019.04.022. Epub 2019 May 14.
The concept of embolic stroke of undetermined source refers to cryptogenic strokes caused by either major or minor risks. Although antiplatelet treatments are most often used for secondary prevention of embolic stroke of undetermined source, optimal strategies remain unclear. To determine the ideal treatment strategy for secondary prevention, we investigated embolic sources among patients with embolic stroke of undetermined source.
The study included 292 consecutive patients (135 men, 157 women; mean age: 74.3 ± 11.6 years) diagnosed with cerebral infarction, 27 of whom were diagnosed with embolic stroke of undetermined source (9.2%; 14 men, 13 women; mean age: 70.7 ± 11.5 years). These 27 patients were examined using contrast-enhanced whole-body computed tomography, transesophageal echocardiography, and Holter electrocardiography. We evaluated whether antiplatelet or anticoagulant treatment was preferred based on the embolic source.
Embolic sources among patients with embolic stroke of undetermined source included valve calcification (11.1%), left ventricle diastolic dysfunction (18.5%), cancer-associated stroke (25.9%), covert atrial fibrillation (7.4%), aortic arch atherosclerotic plaques (11.1%), paradoxical embolism (3.7%), and sick sinus syndrome (3.7%). Embolic sources remained unidentified in 5 patients (18.5%). Our analysis revealed that 21 of the 27 patients (77.8%) with embolic stroke of undetermined source required anticoagulant therapy for secondary prevention.
Although aspirin is the most commonly used antithrombotic drug for embolic stroke of undetermined source, our results suggest that some patients require anticoagulant therapy. Determining embolic sources is important for selecting the appropriate treatment options for this patient population.
不明来源栓塞性卒中的概念是指由主要或次要风险导致的隐源性卒中。尽管抗血小板治疗最常用于不明来源栓塞性卒中的二级预防，但最佳策略仍不明确。为确定二级预防的理想治疗策略，我们调查了不明来源栓塞性卒中患者的栓子来源。
该研究纳入了292例连续诊断为脑梗死的患者（135例男性，157例女性；平均年龄：74.3±11.6岁），其中27例被诊断为不明来源栓塞性卒中（9.2%；14例男性，13例女性；平均年龄：70.7±11.5岁）。对这27例患者进行了对比增强全身计算机断层扫描、经食管超声心动图和动态心电图检查。我们根据栓子来源评估了抗血小板或抗凝治疗是否更可取。
不明来源栓塞性卒中患者的栓子来源包括瓣膜钙化（11.1%）、左心室舒张功能障碍（18.5%）、癌症相关性卒中（25.9%）、隐匿性心房颤动（7.4%）、主动脉弓动脉粥样硬化斑块（11.1%）、反常栓塞（3.7%）和病态窦房结综合征（3.7%）。5例患者（18.5%）的栓子来源仍未明确。我们的分析显示，27例不明来源栓塞性卒中患者中有21例（77.8%）需要抗凝治疗进行二级预防。
尽管阿司匹林是不明来源栓塞性卒中最常用的抗栓药物，但我们的结果表明，一些患者需要抗凝治疗。确定栓子来源对于为该患者群体选择合适的治疗方案很重要。
