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Atherothrombotic ischemic stroke in patients with atrial fibrillation

Gulcin Benbir1, Derya Uluduz, Birsen Ince

  • 1Istanbul University Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul 34098, Turkey. drgulcinbenbir@yahoo.com <drgulcinbenbir@yahoo.com>

Clinical Neurology and Neurosurgery
|May 1, 2007
PubMed

Insights

Patients with non-valvular atrial fibrillation (NVAF) and carotid artery disease often have strokes not solely caused by emboli. Significant carotid stenosis increases atherothrombotic stroke risk, but conventional methods struggle with diagnosis and risk stratification in these complex cases.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Atrial fibrillation is a common cause of embolic stroke.
  • Significant carotid artery disease coexists in about 20% of patients with atrial fibrillation.
  • Stroke etiology in patients with both conditions is complex and not always cardioembolic.

Purpose of the Study:

  • To investigate stroke subtypes in ischemic stroke patients with non-valvular atrial fibrillation (NVAF).
  • To analyze stroke etiology based on clinical, carotid ultrasonographic, and neuroimaging findings.
  • To evaluate the effectiveness of conventional classification systems in these patients.

Main Methods:

  • Classified stroke etiology using Hart et al. criteria and TOAST criteria.
  • Collected data on clinical features and risk factors (age, hypertension, diabetes, etc.).
  • Assessed patients with NVAF and ischemic stroke.

Main Results:

  • Of 1938 patients, 106 (5.5%) had NVAF.
  • Among NVAF patients, 46.3% had definite embolic stroke, 16.0% probable embolic, 11.3% possible atherothrombotic, and 16.0% possible lacunar.
  • Significant carotid stenosis was associated with atherothrombotic stroke (p<0.001), but other risk factors did not differentiate stroke subtypes.

Conclusions:

  • Significant carotid stenosis is linked to atherothrombotic stroke in NVAF patients.
  • Conventional stroke classification systems are inadequate for accurate diagnosis and risk stratification in patients with multiple confounding factors.
  • Further research is needed to refine diagnostic and risk stratification tools for this patient population.
Abstract

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