Yaghi Shadi
Continuum (Minneap Minn). 2023 Apr 1;29(2):462-485. doi: 10.1212/CON.0000000000001217.
Cardioembolic stroke accounts for nearly 30% of ischemic strokes. Prompt diagnosis of the underlying mechanism may improve secondary prevention strategies. This article reviews recent randomized trials, observational studies, case reports, and guidelines on the diagnosis and treatment of cardioembolic stroke.
Several pathologies can lead to cardioembolic stroke, including atrial fibrillation, aortic arch atheroma, patent foramen ovale, left ventricular dysfunction, and many others. Secondary stroke prevention strategies differ across these heterogeneous mechanisms. In addition to medical treatment advances such as the use of direct oral anticoagulants in patients with atrial fibrillation, surgical treatments such as closure of patent foramen ovale have been shown to reduce the risk of recurrent stroke in select patients. Furthermore, left atrial appendage occlusion is a promising strategy for patients with atrial fibrillation who are candidates for short-term oral anticoagulation therapy but not long-term oral anticoagulation therapy.
A thorough diagnostic evaluation is essential to determine cardioembolic causes of stroke. In addition to risk factor management and lifestyle modifications, identification and targeting of the underlying cardioembolic stroke mechanisms will lead to improved stroke prevention strategies in patients with cardioembolic stroke.
心源性栓塞性卒中占缺血性卒中的近30%。迅速诊断潜在机制可能会改善二级预防策略。本文综述了近期关于心源性栓塞性卒中诊断和治疗的随机试验、观察性研究、病例报告及指南。
多种病理情况可导致心源性栓塞性卒中，包括心房颤动、主动脉弓动脉粥样硬化、卵圆孔未闭、左心室功能障碍等。这些不同机制的继发性卒中预防策略各不相同。除了在心房颤动患者中使用直接口服抗凝剂等医学治疗进展外，诸如卵圆孔未闭封堵等外科治疗已被证明可降低特定患者复发性卒中的风险。此外，对于适合短期而非长期口服抗凝治疗的心房颤动患者，左心耳封堵是一种有前景的策略。
全面的诊断评估对于确定卒中的心源性栓塞原因至关重要。除了危险因素管理和生活方式改变外，识别并针对潜在的心源性栓塞性卒中机制将改善心源性栓塞性卒中患者的卒中预防策略。
