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Cryptogenic stroke due to undetected atrial fibrillation – longer ECG monitoring may be the key

23 Jul, 14 | by Alistair Lindsay

Up to 40% of ischemic strokes remain unexplained after routine evaluation and thus are considered cryptogenic. However, a number of these strokes may be due to an undetected episode of paroxysmal atrial fibrillation (AF) where anticoagulation can reduce the risk of subsequent ischemic stokes. Although a minimum of 24 hours of ECG monitoring is guideline recommended in the evaluation of ischemic stroke to identify AF, the optimal duration of monitoring remains undetermined. Among patients with cryptogenic stroke, two concurrent publications evaluated the AF diagnostic yield of extended ECG monitoring. more…

PFO and stroke – to close or not to close?

5 Apr, 12 | by Alistair Lindsay

Approximately 40% of strokes are classified as cryptogenic or as having no identifiable cause.  Some of these cryptogenic strokes may be due to an embolus from the venous circulation crossing into the systemic circulation through a patent foramen ovale (PFO).  While PFOs are certainly common in the general population – with a prevalence of around 25% – they do appear to be more common in patients with cryptogenic stroke, with some series reporting the prevalence to be as high as 56%.  Closure with a percutaneous device is often recommended, but it is not known whether this intervention reduces the risk of recurrent stroke as compared with standard medical therapy alone. more…

Subclinical AF significantly increases stroke risk

29 Jan, 12 | by Alistair Lindsay

Approximately 25% of all strokes are of unknown cause, and it has long been hypothesised that short subclinical episodes of atrial fibrillation (AF) may be an important common etiologic factor.  While several studies have attempted to detect episodes of subclinical AF, most have been hampered by the infrequency of such episodes and the unlikelihood of picking them up even with monitoring over a period of days or weeks.  In the US around 400,000 pacemakers are inserted each year, many of which are able to detect and record episodes of rapid atrial rate, which correlate with electrocardiographically documented atrial fibrillation. In this study Healy et al. evaluated whether subclinical episodes of AF detected by these devices were associated with an increased risk of ischemic stroke. more…

Stroke following CABG and long term outcomes

3 Oct, 11 | by Alistair Lindsay

Stroke is a potentially devastating complication following cardiothoracic surgery with a reported incidence of between 2 and 10%. While numerous risk factors have been described for stroke, little data are available regarding its temporal relationship to the surgical procedure and whether this predicts long term outcomes. more…

Fewer strokes complicate CABG

6 Feb, 11 | by Alistair Lindsay

Stroke is a serious complication of coronary artery bypass grafting (CABG), occurring in around 1.3% of patients undergoing coronary surgery in the USA.  In this study, Tarakji et al. aimed to examine the prevalence and timing of perioperative stroke in the modern era, to identify patient and surgical factors associated with stroke and its timing, and to assess the association of stroke with hospital mortality and morbidity and long-term survival. more…

Clopidogrel and Asprin ACTIVEly prevent stroke

21 Jun, 09 | by Alistair Lindsay

The ACTIVE Trial (Atrial Fibrillation Clopidogrel Trial with Irbesartan for the Prevention of Vascular Events) was designed to assess the role of clopidogrel and aspirin in the prevention of stroke and other vascular events in patients with atrial fibrillation (AF). ACTIVE W has already reported and compared clopidogrel + aspirin with a vitamin K antagonist. The ACTIVE A trial, the results of which are discussed here, compared combination therapy with clopidogrel and aspirin versus aspirin alone in patients with AF who were considered unsuitable for a Vitamin K antagonist. more…

Higher nonfasting triglycerides associated with ischaemic stroke risk

17 Jan, 09 | by Alistair Lindsay

Two recent studies reported a strong association between elevated levels of nonfasting, but not fasting, triglycerides and increased risk of myocardial infarction, ischemic heart disease, and death and total cardiovascular events.  However, to date the evidence regarding the risk of nonfasting triglyceride levels has been less clear. more…

Thrombolysis in stroke: minutes mean mind

14 Oct, 08 | by Alistair Lindsay

The current thrombolysis guidelines for acute ischaemic stroke recommend thrombolysis with alteplase initiated within 3 hours of symptom onset.  This was following the landmark findings of the 1995 National Institute of Neurological Disorders and Stroke (NINDS) study group.  The ECAS III trial (European Cooperative Acute Stroke Study), a multi-centre, randomised, placebo controlled phase 3 trial was designed to test the hypothesis that alteplase administered in patients with acute ischaemic stroke is also effective when given 3-4.5 hours post the onset of symptoms. more…

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