2,597 results match your criteria Cardioembolic Stroke


Cardiogenic cerebral infarction in the parietal lobe predicts the development of post-stroke epilepsy.

Seizure 2020 Jun 20;80:196-200. Epub 2020 Jun 20.

Department of Neurology, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, 820-8505, Fukuoka, Japan. Electronic address:

Purpose: Post-stroke epilepsy (PSE) is a major late complication of cardioembolic cerebral infarction. However, few studies have examined the epileptogenicity and characteristics of first-occurrence cardioembolic cerebral infarctions.

Methods: This retrospective study included 93 consecutive patients with old cardioembolic cerebral infarctions who were classified into two groups based on their epileptic history: patients presenting with PSE or stroke without seizure (SWS). Read More

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http://dx.doi.org/10.1016/j.seizure.2020.06.018DOI Listing

Cardioembolic stroke in a young male with cor triatriatum sinister: a case report.

Eur Heart J Case Rep 2020 Jun 3;4(3):1-6. Epub 2020 May 3.

Department of Cardiology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA.

Background: Cor triatriatum sinister (CTS) is a rare congenital cardiac anomaly defined by a fibromuscular membrane which bisects the left atrium. Cor triatriatum sinister has been associated with cardioembolic stroke through mechanisms including stagnation of blood flow within the left atrium, an association with atrial fibrillation (AF), and/or an accompanying atrial septal defect (ASD) or patent foramen ovale. We describe a case highlighting the role that CTS may play in cardioembolic stroke, provide high-quality computed tomography angiography and two- and three-dimensional echocardiography of the CTS membrane, and outline management strategies for this uncommon clinical scenario. Read More

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http://dx.doi.org/10.1093/ehjcr/ytaa096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319846PMC

Late presentation of left atrial appendage erosion and perforation by an Amplatzer™ Amulet™ closure device: a case report.

Eur Heart J Case Rep 2020 Jun 3;4(3):1-5. Epub 2020 May 3.

Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.

Background: Percutaneous left atrial appendage (LAA) closure may reduce the risk of cardioembolic stroke in patients with non-valvular atrial fibrillation. Given the prophylactic nature of the procedure, identifying and managing complications are paramount.

Case Summary: A 73-year-old man presented 14 months after percutaneous LAA closure with syncope and acute pericardial tamponade which required surgical exploration and haemostasis; the most temporally remote account of this complication albeit amongst very few case reports. Read More

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http://dx.doi.org/10.1093/ehjcr/ytaa079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319829PMC

Genetically determined blood pressure, antihypertensive drug classes, and risk of stroke subtypes.

Neurology 2020 Jul 1. Epub 2020 Jul 1.

From the Institute for Stroke and Dementia Research (ISD), University Hospital (M.K.G., R.M., M.D.), and Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-Universität LMU, Munich, Germany; Department of Biostatistics and Epidemiology, School of Public Health (D.G., E.E., C.L.M.S., A.D., I.T.), UK Dementia Research Institute (P.E., A.D.), Health Data Research-UK London (P.E.), and MRC-PHE Centre for Environment, School of Public Health (I.T.), Imperial College London; Centre for Prevention of Stroke and Dementia, Department of Clinical Neurosciences (A.J.S.W.), University of Oxford, UK; Department of Hygiene and Epidemiology (E.E., I.T.), University of Ioannina Medical School, Greece; National Institute for Health Research Imperial College Biomedical Research Centre (P.E.), London; Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Centre for Neurodegenerative Diseases (DZNE) (M.D.), Munich, Germany.

Objective: We employed Mendelian randomization to explore whether the effects of blood pressure (BP) and BP-lowering through different antihypertensive drug classes on stroke risk vary by stroke etiology.

Methods: We selected genetic variants associated with systolic and diastolic BP and BP-lowering variants in genes encoding antihypertensive drug targets from genome-wide association studies (GWAS) on 757,601 individuals. Applying 2-sample Mendelian randomization, we examined associations with any stroke (67,162 cases; 454,450 controls), ischemic stroke and its subtypes (large artery, cardioembolic, small vessel stroke), intracerebral hemorrhage (ICH, deep and lobar), and the related small vessel disease phenotype of white matter hyperintensities (WMH). Read More

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http://dx.doi.org/10.1212/WNL.0000000000009814DOI Listing

Predicting Surgical Intervention in Cerebellar Stroke: A Quantitative Retrospective Analysis.

World Neurosurg 2020 Jun 26. Epub 2020 Jun 26.

Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States; Methodist University Hospital, Memphis TN, United States.

Background: Debate still exists whether preventive surgical decompression should be offered to high-risk patients experiencing cerebellar stroke.

Objective: To predict neurologic decline based on risk factors, volumetric analysis, and imaging characteristics.

Methods: We performed a retrospective cohort study of patients ≥18 years who presented with acute ischemic cerebellar stroke (January 2011-December 2016). Read More

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http://dx.doi.org/10.1016/j.wneu.2020.06.156DOI Listing

Birth Weight and Stroke in Adult Life: Genetic Correlation and Causal Inference With Genome-Wide Association Data Sets.

Front Neurosci 2020 11;14:479. Epub 2020 Jun 11.

Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China.

Objective: Prior studies have shown that there is an inverse association between birth weight and stroke in adulthood; however, whether such association is causal remains yet known and those studies cannot distinguish between the direct fetal effect and the indirect maternal effect. The aim of the study is to untangle such relationship using novel statistical genetic approaches.

Methods: We first utilized linkage disequilibrium score regression (LDSC) and Genetic analysis incorporating Pleiotropy and Annotation (GPA) to estimate the overall genetic correlation between birth weight and stroke. Read More

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http://dx.doi.org/10.3389/fnins.2020.00479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301963PMC

Intracranial Calcification is Predictive for Hemorrhagic Transformation and Prognosis After Intravenous Thrombolysis in Non-Cardioembolic Stroke Patients.

J Atheroscler Thromb 2020 Jun 27. Epub 2020 Jun 27.

Stroke Center, Department of Neurology, the First Hospital of Jilin University.

Aim: Hemorrhagic transformation is the major complication of intravenous thrombolysis. Calcification is used widely as an imaging indicator of atherosclerotic burden and cerebrovascular function. The relationship between intracranial calcification and hemorrhagic transformation has not been explored fully. Read More

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http://dx.doi.org/10.5551/jat.55889DOI Listing

Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke.

BMC Neurol 2020 Jun 27;20(1):257. Epub 2020 Jun 27.

Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpagu, Seoul, 138-736, Republic of Korea.

Background: Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke.

Methods: Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Read More

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http://dx.doi.org/10.1186/s12883-020-01842-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320547PMC

Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients With Atrial Fibrillation.

J Am Coll Cardiol 2020 Jun;75(25):3122-3135

Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic; Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address:

Background: Percutaneous left atrial appendage closure (LAAC) is noninferior to vitamin K antagonists (VKAs) for preventing atrial fibrillation (AF)-related stroke. However, direct oral anticoagulants (DOACs) have an improved safety profile over VKAs, and their effect on cardiovascular and neurological outcomes relative to LAAC is unknown.

Objectives: This study sought to compare DOACs with LAAC in high-risk patients with AF. Read More

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http://dx.doi.org/10.1016/j.jacc.2020.04.067DOI Listing

Characteristics of aged ischemic stroke patients indicative of cardioembolism.

J Thromb Thrombolysis 2020 Jun 24. Epub 2020 Jun 24.

Division of Neurology, Department of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.

The treatment of ischemic stroke has recently witnessed dramatic developments. However, there are limited data on ischemic stroke characteristics in aged patients. As part of the South Tochigi Acute Ischemic Stroke Registry, we prospectively enrolled 636 consecutive acute ischemic stroke patients (within 7 days after the onset) who were ≥ 60 years of age and who were admitted to two independent institutes from April 1, 2016 to February 28, 2019. Read More

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http://dx.doi.org/10.1007/s11239-020-02198-1DOI Listing

Thrombolysis Outcomes in Acute Ischemic Stroke by Fluid-Attenuated Inversion Recovery Hyperintense Arteries.

Stroke 2020 Jul 17;51(7):2240-2243. Epub 2020 Jun 17.

The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Australia (Z.Z., S.Y., C.D., A.M., T.T.-Y., C.C., X.W., X.C., J.C., C.S.A.).

Background And Purpose: To determine factors associated with fluid-attenuated inversion recovery (FLAIR) hyperintense arteries (FLAIR-HAs) on magnetic resonance imaging and their prognostic significance in thrombolysis-treated patients with acute ischemic stroke from the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) trial alteplase-dose arm.

Methods: Patients with acute ischemic stroke (N=293) with brain magnetic resonance imaging (FLAIR and diffusion-weighted imaging sequences) scanned <4.5 hours of symptom onset were assessed for location and extent (score) of FLAIR-HAs, infarct volume, large vessel occlusion (LVO), and other ischemic signs. Read More

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http://dx.doi.org/10.1161/STROKEAHA.119.028550DOI Listing

Prognostic role of the controlling nutritional status score in acute ischemic stroke among stroke subtypes.

J Neurol Sci 2020 Jun 12;416:116984. Epub 2020 Jun 12.

Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.

Introduction: The association of malnutrition on stroke subtypes has not been well established. We investigated the relationship between malnutrition and functional outcome according to stroke subtypes.

Methods: Acute consecutive ischemic stroke patients (n = 1915, 73 ± 12 years) were analysed. Read More

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http://dx.doi.org/10.1016/j.jns.2020.116984DOI Listing

Incidence and characteristics of spontaneous platelet macro-aggregation in acute ischemic stroke.

J Thromb Thrombolysis 2020 Jun 15. Epub 2020 Jun 15.

Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.

Spontaneous platelet aggregation is a trigger for additional development of larger thrombi. Micro-aggregation is observed in 10% of diabetes approximately and blocked by P2Y12 inhibitors, whereas macro-aggregation is associated with overexpression of platelet α-adrenoreceptors and is not blocked by conventional anti-platelet medicines. We examined the incidence of spontaneous platelet macro-aggregation (SPMA) in acute ischemic stroke and analyzed its clinical characteristics. Read More

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http://dx.doi.org/10.1007/s11239-020-02185-6DOI Listing

Bovine Arch and Stroke Laterality.

J Am Heart Assoc 2020 Jun 17:e015390. Epub 2020 Jun 17.

Department of Radiology Montefiore Medical Center Albert Einstein College of Medicine Bronx NY.

Background Left-hemispheric strokes are more frequent and often have a worse outcome than their right-hemispheric counterparts. This study aimed to evaluate whether cardioembolic stroke laterality is affected by anatomical characteristics of the aortic arch. We hypothesized that laterality varies between patients with bovine versus standard arch. Read More

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http://dx.doi.org/10.1161/JAHA.119.015390DOI Listing

Should the Management of Embolic Stroke in the Elderly Be Changed if They Also Have COVID-19?

Eur J Case Rep Intern Med 2020 25;7(6):001736. Epub 2020 May 25.

Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.

Introduction: A strong association between stroke and atrial fibrillation (AF) has been demonstrated. Anticoagulation for the prevention of stroke in high-risk patients has the benefit of improving the life expectancy, quality of life, autonomy and social functioning of the patient. The COVID-19 pandemic poses challenges for stroke patients because of the association between SARS-CoV-2 infection and thromboembolic risk. Read More

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http://dx.doi.org/10.12890/2020_001736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279903PMC

Cryptogenic stroke over 60 years of age: should patent foramen ovale be closed?

Eur Heart J Suppl 2020 Jun 30;22(Suppl E):E82-E86. Epub 2020 Mar 30.

U.O.C. Cardiologia, Ospedale S. Eugenio, Roma.

Patent foramen ovale (PFO) is an anatomical communication between the left and the right atrium due to the lack of completed sealing of the fossa ovalis. Epidemiologic data, for the most part derived from young populations studies, suggested that PFO, allowing paradoxical embolization of thrombotic material from the venous to the arterial district, could play a significant role in the pathogenesis of cryptogenic ischaemic cerebral events. Recently, three randomized studies in patients ≤60 years of age demonstrated the superiority of percutaneous closure of PFO over medical antithrombotic treatment. Read More

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http://dx.doi.org/10.1093/eurheartj/suaa067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270899PMC

Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study.

J Am Heart Assoc 2020 Jun 4;9(12):e016380. Epub 2020 Jun 4.

Section of Cardiology Wake Forest School of Medicine Winston-Salem NC.

Background Atrial fibrillation (AF) is associated with a 5-fold increased stroke risk. While most patients with AF warrant anticoagulation, optimal treatment remains uncertain for patients with AF without cardiovascular comorbidities because the risk of stroke in this population has not been well-characterized. Methods and Results Participants (N=28 253; 55% women, mean age 64. Read More

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http://dx.doi.org/10.1161/JAHA.120.016380DOI Listing

White matter hyperintensity burden in acute stroke patients differs by ischemic stroke subtype.

Neurology 2020 Jun 3. Epub 2020 Jun 3.

From the Department of Neurology (A.-K.G., M.D.S., K.L.D., M.N., J.R., O.W., N.S.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics (A.K.-G, J.R.), Broad Institute of MIT and Harvard; Computer Science and Artificial Intelligence Lab (M.D.S., A.V.D., R. Sridharan, P.G.), Massachusetts Institute of Technology, Cambridge; Department of Population Health Sciences (M.D.S.), German Centre for Neurodegenerative Diseases, Bonn, Germany; Athinoula A. Martinos Center for Biomedical Imaging (A.V.D., R.I., E.C.M., S.J.T.M., J.R., O.W.), Department of Radiology, Massachusetts General Hospital, Charlestown; Division of Endocrinology, Diabetes and Nutrition (H.X., P.F.M., B.D.M.), Department of Medicine, University of Maryland School of Medicine; Department of Neurology (J.W.C., S.J.K.), University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore; Department of Neurology (E.G.-S., J.J.-C.), Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Spain; Institute of Biomedicine (C.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology and Rehabilitation Medicine (D.O.K., D.W.), University of Cincinnati College of Medicine, OH; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology, University Hospitals Leuven, Department of Neurology, Belgium; Department of Clinical Sciences Lund (J.W., A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden; Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, The Evelyn F. McKnight Brain Institute, FL; Department of Neurology (R. Schmidt), Clinical Division of Neurogeriatrics, Medical University Graz, Austria; Institute of Cardiovascular Research (P.S.), Royal Holloway University of London, Egham, UK; Ashford and St Peter's Hospital (P.S.), UK; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne Heidelberg; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Center for Genomic Medicine (J.R.), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health (J.R.), Boston, MA; and Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL.

Objective: To examine etiologic stroke subtypes and vascular risk factor profiles and their association with white matter hyperintensity (WMH) burden in patients hospitalized for acute ischemic stroke (AIS).

Methods: For the MRI Genetics Interface Exploration (MRI-GENIE) study, we systematically assembled brain imaging and phenotypic data for 3,301 patients with AIS. All cases underwent standardized web tool-based stroke subtyping with the Causative Classification of Ischemic Stroke (CCS). Read More

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http://dx.doi.org/10.1212/WNL.0000000000009728DOI Listing

Dual versus mono antiplatelet therapy for acute non- cardio embolic ischemic stroke or transient ischemic attack, an efficacy and safety analysis - updated meta-analysis.

BMC Neurol 2020 Jun 3;20(1):224. Epub 2020 Jun 3.

Cardinal Santos Medical Center, 10 Wilson St. Greenhills West, 1502, San Juan City, NCR, Philippines.

Background: New evidence on the efficacy and safety of dual antiplatelet therapy for secondary stroke prevention have been realized in the recent years. An updated meta analysis was done to determine the effect of the various dual antiplatelets vs aspirin alone on recurrence rate of ischemic stroke, cardiovascular morbidity and mortality, and its safety profile as reported through major bleeding.

Methods: PubMed, Cochrane and Science Direct data bases were utilized, RCTs evaluating dual antiplatelet vs mono antiplatelet therapy for acute ischemic stroke or transient ischemic attack within < 72 h from ictus were searched up to July 2019. Read More

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http://dx.doi.org/10.1186/s12883-020-01808-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268473PMC

Discussing the Score of Cardioembolic Ischemic Stroke in Chagas Disease.

Trop Med Infect Dis 2020 May 26;5(2). Epub 2020 May 26.

Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Rio de Janeiro 21045-900, Brazil.

Chagas disease is an important infection in Latin America but it is also reported in non-endemic countries all over the world. Around 30% of infected patients develop chronic Chagas cardiopathy, which is responsible for most poor outcomes, mainly heart failure, arrhythmias and thromboembolic events. Of all thromboembolic events, stroke is the most feared, due to the high probability of evolution to death or disability. Read More

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http://dx.doi.org/10.3390/tropicalmed5020082DOI Listing

Ischaemic stroke and SARS-CoV-2 infection: A causal or incidental association?

Neurologia 2020 Jun 11;35(5):295-302. Epub 2020 May 11.

Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España.

Introduction: Ischaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and hypercoagulability secondary to the infection.

Methods: We describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Read More

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http://dx.doi.org/10.1016/j.nrl.2020.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211755PMC

Left atrial appendage occlusion in patients with atrial fibrillation and large prevalence of prior intracranial bleeding.

J Cardiovasc Med (Hagerstown) 2020 Aug;21(8):583-591

Unità Operativa di Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.

Background: Left atrial appendage occlusion (LAAO) represents an alternative approach for the prevention of cardioembolic stroke in patients with nonvalvular atrial fibrillation (NVAF) and contraindication for oral anticoagulation (OAC). The aim of our study was to analyse the outcomes in patients treated with LAAO, with a focus on cases with previous intracranial bleeding.

Methods: Sixty patients with NVAF underwent LAAO (75. Read More

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http://dx.doi.org/10.2459/JCM.0000000000000976DOI Listing
August 2020
1.407 Impact Factor

Measuring atrial stasis during sinus rhythm in patients with paroxysmal atrial fibrillation using 4 Dimensional flow imaging: 4D flow imaging of atrial stasis.

Int J Cardiol 2020 May 19. Epub 2020 May 19.

Baker Heart & Diabetes Institute, Melbourne, Australia; Heart Centre, The Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University. Electronic address:

Background: Paroxysmal atrial fibrillation (PAF) is associated with cardioembolic risk, however events may occur during sinus rhythm (SR). 4D-flow cardiac magnetic resonance (CMR) imaging allows visualisation of left atrial blood flow, to determine the residence time distribution (RTD), an assessment of atrial transit time.

Objective: To determine if atrial transit time is prolonged in PAF patients during SR, consistent with underlying atrial stasis. Read More

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http://dx.doi.org/10.1016/j.ijcard.2020.05.012DOI Listing

Direct-acting oral anticoagulant use at extremes of body weight: Literature review and recommendations.

Am J Health Syst Pharm 2020 05;77(11):865-876

South College School of Pharmacy, Knoxville, TN.

Purpose: To review the literature on treatment of venous thromboembolism (VTE) and prevention of cardioembolic stroke with direct-acting oral anticoagulants (DOACs) in low- and high-body-weight patients and to make recommendations regarding agent selection and dosing in these patient populations.

Summary: The selection and optimal dosing of DOACs in low- and high-body-weight patients has not yet been fully elucidated by clinical trials; however, evidence suggests that issues of both safety and efficacy in patients at the extremes of body weight may warrant careful consideration when selecting a DOAC for such patients. This review provides a thorough discussion of the use of DOACs in the treatment of VTE and prevention of cardioembolic stroke in patients at the extremes of body weight and provides guidance regarding agent selection. Read More

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http://dx.doi.org/10.1093/ajhp/zxaa059DOI Listing

Factors associated with therapeutic anticoagulation status in patients with ischemic stroke and atrial fibrillation.

J Stroke Cerebrovasc Dis 2020 Jul 13;29(7):104888. Epub 2020 May 13.

Department of Neurology, Spectrum Health, Grand Rapids, MI, USA.

Background And Purpose: Understanding factors associated with ischemic stroke despite therapeutic anticoagulation is an important goal to improve stroke prevention strategies in patients with atrial fibrillation (AF). We aim to determine factors associated with therapeutic or supratherapeutic anticoagulation status at the time of ischemic stroke in patients with AF.

Methods: The Initiation of Anticoagulation after Cardioembolic stroke (IAC) study is a multicenter study pooling data from stroke registries of eight comprehensive stroke centers across the United States. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104888DOI Listing

The Relation Between Aortic Arch Branching Types and the Laterality of Cardio-Embolic Stroke.

J Stroke Cerebrovasc Dis 2020 Jul 13;29(7):104917. Epub 2020 May 13.

Department of Neuroscience, Stroke Unit - Neurology Clinic, Ospedale Civile di Baggiovara, AOU di Modena, Italy; Faculty of Medicine, Department of Neurology, Mansoura University, Mansoura 35511, Egypt. Electronic address:

Background And Purpose: The trajectory of cardiogenic emboli could be affected by anatomical and flow characteristics of the aortic arch. We aimed to study the relation between the different aortic arch patterns and the laterality of cardiogenic emboli.

Methods: 192 cardioembolic strokes were classified into 3 groups according to the type of the aortic arch; type 1 (n = 69), type 2 (n = 49), type 3 (n = 74). Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104917DOI Listing

Impact of complete recanalization on clinical recovery in cardioembolic stroke patients with M2 occlusion.

J Neurol Sci 2020 May 5;415:116873. Epub 2020 May 5.

Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.

Background And Purpose: We investigated the impact of complete recanalization beyond partial recanalization in distal (M2) middle cerebral artery (MCA) occlusion.

Methods: Data regarding M2 occlusion patients treated with endovascular thrombectomy (EVT) and/or intravenous thrombolysis (tPA) were reviewed from our prospective EVT registry and multicenter tPA (YAMATO study) data bank. Complete recanalization was modified thrombolysis with cerebral infarction score (TICI) of 3 at the end of EVT or similar appearances of both MCAs on magnetic resonance angiography (MRA) within 1. Read More

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http://dx.doi.org/10.1016/j.jns.2020.116873DOI Listing

Early ischaemic and haemorrhagic complications after atrial fibrillation-related ischaemic stroke: analysis of the IAC study.

J Neurol Neurosurg Psychiatry 2020 Jul 13;91(7):750-755. Epub 2020 May 13.

Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.

Introduction: Predictors of long-term ischaemic and haemorrhagic complications in atrial fibrillation (AF) have been studied, but there are limited data on predictors of early ischaemic and haemorrhagic complications after AF-associated ischaemic stroke. We sought to determine these predictors.

Methods: The Initiation of Anticoagulation after Cardioembolic stroke study is a multicentre retrospective study across that pooled data from consecutive patients with ischaemic stroke in the setting of AF from stroke registries across eight comprehensive stroke centres in the USA. Read More

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http://dx.doi.org/10.1136/jnnp-2020-323041DOI Listing

Stroke Etiology and Thrombus Computed Tomography Characteristics in Patients With Acute Ischemic Stroke: A MR CLEAN Registry Substudy.

Stroke 2020 Jun 14;51(6):1727-1735. Epub 2020 May 14.

From the Department of Radiology and Nuclear Medicine (N.B., K.C.J.C., N.S., A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.

Background and Purpose- If a relationship between stroke etiology and thrombus computed tomography characteristics exists, assessing these characteristics in clinical practice could serve as a useful additional diagnostic tool for the identification of stroke subtype. Our purpose was to study the association of stroke etiology and thrombus computed tomography characteristics in patients with acute ischemic stroke due to a large vessel occlusion. Methods- For 1429 consecutive patients enrolled in the MR CLEAN Registry, we determined stroke cause as defined by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. Read More

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http://dx.doi.org/10.1161/STROKEAHA.119.027749DOI Listing

Diagnostic accuracy of acute infarcts in multiple cerebral circulations for cardioembolic stroke: Literature review and meta-analysis.

J Stroke Cerebrovasc Dis 2020 Jul 10;29(7):104849. Epub 2020 May 10.

Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States. Electronic address:

Objective: To determine the diagnostic value of acute infarcts in multiple cerebral circulations (AIMCC) on MRI diffusion-weighted imaging (DWI) for cardioembolism (CE) stroke subtype in adult patients hospitalized with acute ischemic stroke, we conducted a systematic literature review and meta-analysis.

Methods: MEDLINE was searched via PubMed for articles reporting patients hospitalized with acute ischemic stroke with MRI DWI categorized as AIMCC vs other and use of Trial of Org 10172 in Acute Stroke Treatment (TOAST) Criteria for cardioembolism subtype. Measures of diagnostic accuracy were calculated from the retrieved studies. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104849DOI Listing

Repeated mechanical thrombectomy in short-term large vessel occlusion recurrence: multicenter study and systematic review of the literature.

J Neurointerv Surg 2020 May 6. Epub 2020 May 6.

Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany.

Background: Data on the frequency and outcome of repeated mechanical thrombectomy (MT) in patients with short-term re-occlusion of intracranial vessels is limited. Addressing this subject, we report our multicenter experience with a systematic review of the literature.

Methods: A retrospective analysis was conducted of consecutive acute stroke patients treated with MT repeatedly within 30 days at 10 tertiary care centers between January 2007 and January 2020. Read More

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http://dx.doi.org/10.1136/neurintsurg-2020-015938DOI Listing

[Papillary fibroelastoma in the cardiologist's practice].

Kardiologiia 2020 Mar 18;60(3):145-148. Epub 2020 Mar 18.

State Healthcare Institution "Cardiac surgery clinical hospital" of Nizhny Novgorod region.

The article presents a clinical case of diagnosis and treatment of a rare disease, multiple papillary fibroelastoma associated with a relapse and a complication in the form of cardioembolic stroke. The authors stressed difficulties in diagnostics of this disease and a special role of the physician-patient interaction. Read More

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http://dx.doi.org/10.18087/cardio.2020.3.n1006DOI Listing

Does Intravenous Thrombolysis Influence the Time of Recanalization and Success of Mechanical Thrombectomy during the Acute Phase of Cerebral Infarction?

Cerebrovasc Dis Extra 2020 28;10(1):28-35. Epub 2020 Apr 28.

Interventional Neuroradiology department, Besançon University Hospital, Besançon, France.

Objectives: Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke (AIS) caused by large vessel occlusion. Recanalization time is a key factor in the treatment of AIS. It has previously been suggested that intravenous thrombolysis (IVT) may be associated with a shorter recanalization time. Read More

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http://dx.doi.org/10.1159/000507119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289153PMC

Early Dabigatran Treatment After Transient Ischemic Attack and Minor Ischemic Stroke Does Not Result in Hemorrhagic Transformation.

Can J Neurol Sci 2020 Apr 28:1-8. Epub 2020 Apr 28.

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

Objectives: The optimal timing of anticoagulation after ischemic stroke in atrial fibrillation (AF) patients is unknown. Our aim was to demonstrate the feasibility and safety of initiating dabigatran therapy within 14 days of transient ischemic attack (TIA) or minor stroke in AF patients.

Patients And Methods: A prospective, multi-center registry (NCT02415855) in patients with AF treated with dabigatran within 14 days of acute ischemic stroke/TIA (National Institutes of Health Stroke Scale (NIHSS) ≤ 3) onset. Read More

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http://dx.doi.org/10.1017/cjn.2020.84DOI Listing
April 2020
1.599 Impact Factor

Clopidogrel response in ischemic stroke patients: Is polymorphism or gender more important? Results of the CRISP study.

J Clin Neurosci 2020 Jun 18;76:81-86. Epub 2020 Apr 18.

Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address:

Clopidogrel (CLP) is a second generation thienopyridine drug commonly used in secondary prevention of ischemic stroke (IS). Its antiplatelet response maybe variable due to genetic and non-genetic factors. Adipokines may affect platelet aggregation through ADP mediated platelet signalling. Read More

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http://dx.doi.org/10.1016/j.jocn.2020.04.038DOI Listing
June 2020
1.318 Impact Factor

"Incidence and Clinico-Radiological Correlations of Early Arterial Reocclusion After Successful Thrombectomy in Acute Ischemic Stroke".

Transl Stroke Res 2020 Apr 20. Epub 2020 Apr 20.

Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 170 Villarroel, 08036, Barcelona, Spain.

About half of acute stroke patients treated with mechanical thrombectomy (MT) do not show clinical improvement despite successful recanalization. Early arterial reocclusion (EAR) may be one of the causes that explain this phenomenon. We aimed to analyze the incidence and clinico-radiological correlations of EAR after successful MT. Read More

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http://dx.doi.org/10.1007/s12975-020-00816-xDOI Listing

Challenges of Thrombolysis in a Developing Country: Characteristics and Outcomes in Peru.

J Stroke Cerebrovasc Dis 2020 Jul 16;29(7):104819. Epub 2020 Apr 16.

Department of Neurology, Harborview Medical Center, University of Washington, Seattle, Washington. Electronic address:

Background: The availability of intravenous tissue plasminogen activator (IV-tPA) remains limited worldwide, especially in low-income countries, where the burden of disability due to ischemic stroke is the highest.

Aims: To evaluate outcomes and safety of IV-tPA at the only Peruvian reference institute for neurologic diseases.

Methods: We conducted a prospective, observational study of stroke patients who received IV-tPA between 2009 and 2016. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104819DOI Listing

The management of patients with acute ischemic stroke while on direct oral anticoagulants (DOACs): data from an Italian cohort and a proposed algorithm.

J Thromb Thrombolysis 2020 Apr 17. Epub 2020 Apr 17.

Neurology and Radiology Unit, Guglielmo da Saliceto Hospital, AUSLPC, Piacenza, PC, Italy.

Approximately 1-2% of patients with non-valvular atrial fibrillation have an acute ischemic stroke (AIS) while on direct oral anticoagulant (DOAC) treatment every year. However, current evidence on stroke subtypes, pathophysiology and factors leading to the failure of DOAC preventive therapy in a "real world" setting is still scanty. This study aimed at investigating whether there is any relationship between DOAC plasma levels and the stroke occurrence, on the basis of the phenotypic classification and pathophysiology of the stroke, in a cohort of DOAC-treated patients admitted to our hospital for AIS over 1-year period. Read More

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http://dx.doi.org/10.1007/s11239-020-02108-5DOI Listing

Statin therapy in acute cardioembolic stroke with no guidance-based indication.

Neurology 2020 May 9;94(19):e1984-e1995. Epub 2020 Apr 9.

From the Department of Neurology (H.-K.P., K.-S.H., Y.-J.C.), Inje University Ilsan Paik Hospital, Goyang; Clinical Research Center (J.S.L.), Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine; Department of Neurology (J.-M.P., K.K.), Nowon Eulji Medical Center, Eulji University, Seoul; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Eulji University, Daejeon; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (M.-K.H., B.J.K., H.-J.B.), Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.-T.K., K.-H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (D.-E.K., W.-S.R.), Dongguk University Ilsan Hospital, Goyang; Department of Neurology (J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Neurology (J.-H.K., W.-J.K.), Ulsan University College of Medicine; Department of Neurology (D.-I.S.), Chungbuk University Hospital, Cheongju; Department of Neurology (S.I.S., J.-H.H.), Keimyung University Dongsan Medical Center, Daegu; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; Department of Translational Science and Molecular Medicine (P.B.G.), Michigan State University College of Human Medicine; and Mercy Health Hauenstein Neurosciences (P.B.G.), Grand Rapids, MI.

Objective: It is uncertain whether patients with cardioembolic stroke and without a guidance-based indication for statin therapy should be administered a statin for prevention of subsequent vascular events. This study was performed to determine whether the statin therapy is beneficial in preventing major vascular events in this population.

Methods: Using a prospective multicenter stroke registry database, we identified patients with acute cardioembolic stroke who were hospitalized between 2008 and 2015. Read More

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http://dx.doi.org/10.1212/WNL.0000000000009397DOI Listing

Central Nervous System Fungal Infection-Related Stroke: A Descriptive Study of Mold and Yeast-Associated Ischemic Stroke.

J Stroke Cerebrovasc Dis 2020 Jun 4;29(6):104759. Epub 2020 Apr 4.

Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio.

Objective: Central nervous system (CNS) ischemic events caused by fungal infections are rare, and clinical characteristics of these ischemic events are largely unknown. The objective of this manuscript is to highlight characteristics of fungal-related strokes and describe possible mechanistic differences between CNS mold and yeast infection-related strokes.

Methods: We report a single-center retrospective case series of all adult patients who presented with concurrent CNS fungal infection and stroke between 2010 and 2018. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104759DOI Listing

Limitations of transoesophageal echocardiogram in acute ischaemic stroke.

Open Heart 2020 24;7(1):e001176. Epub 2020 Mar 24.

Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, Texas, USA.

Objective: The role of transoesophageal echocardiography (TOE) in identifying ischaemic stroke aetiology is debated. In 2018, the American Heart Association/American Stroke Association (AHA/ASA) issued class IIa recommendation for echocardiography, with the qualifying statement of use in cases where it will alter management. Hence, we sought to determine the rate at which TOE findings altered management in cases of confirmed ischaemic stroke. Read More

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http://dx.doi.org/10.1136/openhrt-2019-001176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103838PMC

Atrial Fibrillation Risk and Discrimination of Cardioembolic From Noncardioembolic Stroke.

Stroke 2020 May 7;51(5):1396-1403. Epub 2020 Apr 7.

Cardiac Arrhythmia Service, Division of Cardiology, (P.T.E., S.A.L.), Massachusetts General Hospital, Boston.

Background and Purpose- Classification of stroke as cardioembolic in etiology can be challenging, particularly since the predominant cause, atrial fibrillation (AF), may not be present at the time of stroke. Efficient tools that discriminate cardioembolic from noncardioembolic strokes may improve care as anticoagulation is frequently indicated after cardioembolism. We sought to assess and quantify the discriminative power of AF risk as a classifier for cardioembolism in a real-world population of patients with acute ischemic stroke. Read More

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http://dx.doi.org/10.1161/STROKEAHA.120.028837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188588PMC

Assessment of the manifestations of atrial fibrillation in patients with acute cerebral stroke - a single-center study based on 998 patients.

Neurol Res 2020 Jun 2;42(6):471-476. Epub 2020 Apr 2.

Department of Neurology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland.

: Cardioembolic stroke accounts for approximately 15-25% of ischemic strokes and is characterized by a poor prognosis. Atrial fibrillation (AF) is more commonly diagnosed in the elderly.The aim of the study was the assessment of the manifestations of AF in patients hospitalized due to cerebral stroke, with particular attention paid to newly diagnosed AF. Read More

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http://dx.doi.org/10.1080/01616412.2020.1746508DOI Listing

[Surgical considerations for two patients with cardioembolic stroke and mobile thrombus in the left atrium appendage].

Rinsho Shinkeigaku 2020 Apr 31;60(4):278-284. Epub 2020 Mar 31.

Department of Neurology, Japanese Red Cross Matsue Hospital.

Two men (Case 1, 74 years old; Case 2, 65 years old) developed cardioembolic stroke due to self-interruption of anticoagulants for treating atrial fibrillation. They both had mobile thrombus in the left atrial appendage. In Case 1, a left atrial thrombectomy was scheduled on day 8, but infarction re-occurred on the morning of the the surgery, producing neurological sequelae. Read More

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http://dx.doi.org/10.5692/clinicalneurol.cn-001394DOI Listing

Stroke Rate, Subtype, and Cardiovascular Risk Factors in Nonarteritic Anterior Ischemic Optic Neuropathy: A Population-Based Study.

J Neuroophthalmol 2020 Mar 26. Epub 2020 Mar 26.

Department of Ophthalmology (RCF, MTB, JJC), Mayo Clinic; Mayo Clinic (OMC), College of Medicine, Rochester, Minnesota; and Departments of Health Sciences Research (ERL, DOH), and Neurology (MTB, JPK, JJC), Mayo Clinic, Rochester, Minnesota.

Background: Nonarteritic anterior ischemic optic neuropathy (NAION) is a common cause of acute optic neuropathy in adults and is associated with vascular risk factors. Owing to the overlapping risk factor profiles between NAION and cerebral stroke, previous studies have produced conflicting results with regard to NAION as an independent risk factor for stroke.

Methods: A retrospective chart review was conducted using the Rochester Epidemiology Project database to identify all cases of NAION occurring among Olmsted County, Minnesota residents from January 1, 1990, through December 31, 2016. Read More

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http://dx.doi.org/10.1097/WNO.0000000000000923DOI Listing

Increased Rate of Pump Thrombosis and Cardioembolic Events Following Ventricular Tachycardia Ablation in Patients Supported With Left Ventricular Assist Devices.

ASAIO J 2020 Mar 27. Epub 2020 Mar 27.

Division of Cardiology, Columbia University, New York, NY.

Ventricular arrhythmias are common following left ventricular assist device implantation (LVAD), and the effects of ventricular tachycardia (VT) ablation on thrombosis and embolic events are unknown. We aimed to assess LVAD thrombosis, stroke, and embolic event rates after VT ablation. Left ventricular assist device implantation patients from two academic centers who underwent endocardial VT ablation between 2009 and 2016 were compared to a control group with VT who were not ablated and followed for one year. Read More

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http://dx.doi.org/10.1097/MAT.0000000000001155DOI Listing

Medical Management for Secondary Stroke Prevention.

Authors:
Anthony S Kim

Continuum (Minneap Minn) 2020 Apr;26(2):435-456

Purpose Of Review: This article reviews the evidence base and recommendations for medical management for secondary stroke prevention.

Recent Findings: Recent developments for secondary stroke prevention include evidence to support the use of short-term dual antiplatelet therapy after minor stroke and transient ischemic attack, direct oral anticoagulants for nonvalvular atrial fibrillation, reversal agents for direct oral anticoagulant-associated hemorrhage, and aspirin rather than presumptive anticoagulation with a direct oral anticoagulant for embolic stroke of undetermined source.

Summary: Most strokes are preventable. Read More

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http://dx.doi.org/10.1212/CON.0000000000000849DOI Listing

Circulating interleukins in relation to coronary artery disease, atrial fibrillation and ischemic stroke and its subtypes: A two-sample Mendelian randomization study.

Int J Cardiol 2020 Aug 21;313:99-104. Epub 2020 Mar 21.

Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. Electronic address:

Background: The causal role of interleukins (ILs) for cardiovascular disease has not been fully elucidated. We conducted a Mendelian randomization study to investigate the associations of circulating ILs with coronary artery disease (CAD), atrial fibrillation (AF), and ischemic stroke.

Methods And Results: Single-nucleotide polymorphisms associated with IL-1β, IL-1 receptor antagonist (IL-1ra), IL-2 receptor subunit alpha, IL-6, IL-16, IL-17 and IL-18 were identified from genome-wide association studies. Read More

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http://dx.doi.org/10.1016/j.ijcard.2020.03.053DOI Listing

Cilostazol uncovers covert atrial fibrillation in non-cardioembolic stroke.

J Neurol Sci 2020 Jun 21;413:116796. Epub 2020 Mar 21.

Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan.

Background: We hypothesized that administration of cilostazol may clarify the occult atrial fibrillation (AF) during hospitalization in mild stroke patients, who has no history of AF.

Methods: From our prospective non-cardioembolic stroke study, randomized to dual antiplatelet therapy using cilostazol and aspirin or aspirin alone trial (ADS), data on the presence or absence of AF were retrospectively analyzed. In the ADS, during hospitalization, as a routine examination, presence of AF was investigated using electrocardiogram (ECG), ECG monitoring and Holter ECG. Read More

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http://dx.doi.org/10.1016/j.jns.2020.116796DOI Listing

Independent Prognostic Value of MRproANP (Midregional Proatrial Natriuretic Peptide) Levels in Patients With Stroke Is Unaltered Over Time.

Stroke 2020 Jun 27;51(6):1873-1875. Epub 2020 Mar 27.

From the Department of Neurology, University Hospital of Zurich, Switzerland (M.A., A.L., M.K.).

Background and Purpose- MRproANP (midregional proatrial natriuretic peptide) is known to be independently associated with cardioembolic stroke cause and to improve risk stratification for 90-day mortality when measured within 24 to 72 hours after symptom onset in patients with acute ischemic stroke. However, the optimal time point for assessment remains unclear. This study aimed to evaluate prognostic utility of MRproANP at different time points during the first 5 days of hospitalization in patients with acute ischemic stroke. Read More

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http://dx.doi.org/10.1161/STROKEAHA.120.029333DOI Listing