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Updated: Nov 7, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
[Cerebral amyloid angiopathy, comorbid atrial fibrillation]
O A Novosadova1, T N Semenova1, V N Grigoryeva1
1Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
Insights
Cerebral amyloid angiopathy (CAA) complicates atrial fibrillation (AF) management due to hemorrhage risks with antithrombotics. MRI aids probable CAA diagnosis, guiding stroke prevention strategies in co-occurring conditions.
Area of Science:
- Neurology
- Neuroradiology
- Cardiology
Background:
- Cerebral amyloid angiopathy (CAA), linked to aging and cardiovascular disease, involves amyloid-beta deposition in cerebral vessels.
- The increasing recognition of CAA is attributed to advancements in neuroimaging technologies.
- Managing patients with both CAA and atrial fibrillation (AF) presents challenges due to contraindications for antithrombotic therapy.
Observation:
- A case report details a patient with AF experiencing an acute ischemic stroke, classified as undetermined etiology by TOAST.
- MRI revealed findings suggestive of probable CAA, including micro-hemorrhages, enlarged perivascular spaces, and specific signal characteristics.
- The stroke's location and size precluded classification as lacunar or cardioembolic under TOAST criteria.
Findings:
- Probable CAA diagnosis was established using MRI data consistent with the 2010 Boston criteria and 2019 International CAA Association recommendations.
- The study highlights both hemorrhagic and non-hemorrhagic MRI features indicative of CAA.
- Cortical microinfarcts in CAA are discussed, differentiating them from small cardioembolic infarcts in AF.
Implications:
- Accurate diagnosis of CAA in AF patients is crucial for appropriate stroke management.
- Understanding MRI features of CAA is vital for differentiating stroke etiologies.
- Developing safe antithrombotic strategies for secondary stroke prevention in this complex patient group is essential.
Abstract:
Cerebral amyloid angiopathy (CAA) is caused by the deposition of β-amyloid in small vessels in the cerebral cortex and leptomeninges. Nowadays, CAA is recognized more often due to the development of neuroimaging technologies. The frequency of CAA increases in old age that explains its frequent association with cardiovascular diseases. Combination of CAA with atrial fibrillation (AF) causes particular difficulties in managing of the patients, since antithrombotic drugs prescribed to patients with AF mostly contraindicated in CAA because of increased risk of intracerebral hemorrhages. The article presents a case report of the patient with AF who was admitted to the stroke center with acute ischemic stroke. According to MRI, the focus of acute ischemia was small and localized in the cerebellum. This stroke was regarded as having an undetermined etiology according TOAST classification. Small-vessel occlusion subtype was not diagnosed because the TOAST criteria do not attribute an ischemic focus in the cerebellum to a lacunar stroke, while cardioembolic subtype was rejected due to a small (less than 1.5 cm in diameter) size of the focus. Probable CAA in the patient was diagnosed on the basis of the following MRI data: multiple cortical-subcortical micro-hemorrhages (T2*GRE); a single cortical focus with features of the hemorrhage at the stage of intracellular methemoglobin deposition (T1- weighted MR images); bilateral enlargement of perivascular spaces in semioval centers (FLAIR); a negative fronto-occipital gradient (T2-weighted MR images). A diagnosis of CAA was made in accordance with the 2010 Boston criteria and 2019 recommendations of the International CAA Association. The article discusses the hemorrhagic and non-hemorrhagic MRI features of CAA. Frequency of occurrence of cortical microinfarcts in CAA is discussed as well as their differences from small cardioembolic infarcts in AF. Algorithms for antithrombotic therapy for secondary prevention of ischemic stroke in patients with CAA and AF are considered.
