Johansen Michelle C, De Vasconcellos Henrique Doria, Gottesman Rebecca F
Department of Neurology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 4 Suite 446, Baltimore, MD, 21287, USA.
Department of Cardiology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 4 Suite 446, Baltimore, MD, 21287, USA.
Curr Treat Options Neurol. 2019 Jun 25;21(7):32. doi: 10.1007/s11940-019-0571-4.
Ischemic stroke is the fifth leading cause of death in the world with cardioembolic stroke (CES) causing a disproportional amount of the morbidity and mortality associated with stroke. Atrial fibrillation (AF) is the leading cause of CES, and as the population ages, the incidence of CES is anticipated to rise. The importance of proper diagnosis and treatment of patients with embolic-appearing stroke is significant due to the burden of disease and the severity of the illness.
The past decade has seen an explosion of treatment options for patients with CES related to AF as well as better mechanisms by which to monitor and diagnose patients with AF. While optimal secondary prevention of stroke with anticoagulation in the setting of AF is known, what remains to be defined is the appropriate treatment of other types of strokes that appear embolic, but no source of the embolism is discovered. In this article, we will review what is known about the diagnosis and treatment of CES, discuss the emergence of novel therapeutics and emphasize what must be investigated in the future to move the field forward, such as the emerging concept of atrial cardiopathy.
缺血性卒中是全球第五大致死原因，心源性栓塞性卒中（CES）导致了与卒中相关的不成比例的发病率和死亡率。心房颤动（AF）是CES的主要原因，随着人口老龄化，CES的发病率预计会上升。由于疾病负担和病情严重程度，对疑似栓塞性卒中患者进行正确诊断和治疗非常重要。
在过去十年中，针对与AF相关的CES患者的治疗选择激增，同时监测和诊断AF患者的机制也有所改善。虽然已知在AF情况下通过抗凝进行最佳二级预防卒中，但仍有待确定的是对其他类型看似栓塞性但未发现栓塞源的卒中的适当治疗方法。在本文中，我们将回顾关于CES诊断和治疗的已知内容，讨论新型疗法的出现，并强调未来为推动该领域发展必须进行研究的内容，如心房心肌病这一新兴概念。
