Cardiovascular causes of stroke

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Cardiovascular causes of stroke

  1. Atrial fibrillation / flutter

  2. Patent foramen ovale (PFO) with right to left shunt or atrial septal aneurysm

  3. Cardiomyopathy

  4. Aortic arch atheroma

  5. Valvular heart disease with intracardiac thrombi or vegetations

  6. Atrial myxoma and fibroelastoma

  7. Mural thrombus in myocardial infarction

Two recent trials (Gore REDUCE and CLOSE) [1,2] and long term outcome results of RESPECT trial [3] provide clear evidence for PFO closure for stroke prevention in those below 60 years with high risk – PFO. High risk PFO is one with substantial right to left shunting or an atrial septal aneurysm.

References

  1. Sondergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen-Kudsk JE, Settergren M, Sjostrand C, Roine RO, Hildick-Smith D, Spence JD, Thomassen L; Gore REDUCE Clinical Study Investigators. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med. 2017;377:1033–1042.

  2. Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, Arquizan C, Bejot Y, Vuillier F, Detante O, Guidoux C, Canaple S, Vaduva C, Dequatre-Ponchelle N, Sibon I, Garnier P, Ferrier A, Timsit S, Robinet-Borgomano E, Sablot D, Lacour JC, Zuber M, Favrole P, Pinel JF, Apoil M, Reiner P, Lefebvre C, Guérin P, Piot C, Rossi R, Dubois-Randé JL, Eicher JC, Meneveau N, Lusson JR, Bertrand B, Schleich JM, Godart F, Thambo JB, Leborgne L, Michel P, Pierard L, Turc G, Barthelet M, Charles-Nelson A, Weimar C, Moulin T, Juliard JM, Chatellier G; CLOSE Investigators. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017;377:1011–1021.

  3. Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS, Tirschwell DL; RESPECT Investigators. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med. 2017;377:1022–1032.