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- Title
Noncardioembolic Stroke in Patients with Atrial Fibrillation.
- Authors
Katsi, Vasiliki; Georgiopoulos, Georgios; Skafida, Anastasia; Oikonomou, Dimitrios; Klettas, Dimitrios; Vemmos, Konstantinos; Tousoulis, Dimitris
- Abstract
Atrial fibrillation (AF) could be a coincidental finding in certain patients with ischemic stroke and increased burden of underlying cardiovascular disease. Concomitant large-vessel atheromatosis and cerebral small vessel disease may be the actual cause of stroke, and distinguishing between different pathophysiologic mechanisms could impose substantial diagnostic difficulties. Despite routine use of oral anticoagulants (OACs) in patients with AF based on their risk for embolism (ie, CHA2DS2-Vasc score), antithrombotic agents may exert differential effects depending on stroke etiology and stroke subtyping should be evaluated as an additional component of risk stratification that could facilitate optimal management. In the present study, we summarize the evidence on noncardioembolic (non-CE) stroke and treatment approaches based on different stroke subtypes in patients with AF. In particular, approximately one-third of patients with AF seem to suffer a non-CE stroke. Within this category, 11% to 24% of patients present high-grade carotid stenosis and 9% to 16% of ischemic strokes are classified as lacunar. In terms of secondary prevention, the effectiveness of OACs in preventing non-CE stroke has been disputed. Additional large-scale prospective studies are warranted to assess the pathophysiologic stroke mechanisms in patients with AF and compare the differential efficacy of antithrombotic treatment strategies in non-CE ischemic syndromes.
- Subjects
EMBOLISM risk factors; CAROTID artery stenosis; STROKE risk factors; STROKE prevention; STROKE diagnosis; FIBRINOLYTIC agents; ANTICOAGULANTS; ATRIAL fibrillation; INFORMATION storage &; retrieval systems; MEDICAL databases; MEDICAL information storage &; retrieval systems; MEDLINE; RISK assessment; STROKE; SYSTEMATIC reviews; CEREBRAL small vessel diseases; DISEASE complications; DISEASE risk factors
- Publication
Angiology, 2019, Vol 70, Issue 4, p299
- ISSN
0003-3197
- Publication type
Article
- DOI
10.1177/0003319718791711