SUMMARYThe association between non-rheumatic atrial fibrillation (AF) and stroke has been studied in 402 patients consecutively admitted to a stroke unit. Brain infarction patients with sinus rhythm (n = 196) and non-rheumatic AF (n = 92) were further compared. Some findings supported an embolic origin of the stroke: half of the deceased AF patients (n = 24) at autopsy either had left atrial thrombosis or arterial embolism compared to none of the ten with sinus rhythm. Patients with AF also had a higher mortality and more severe brain lesions, findings compatible with a sudden occlusion of blood flow. However, these differences might also be explained by an atherothrombotic occlusion with impaired autoregulation in the ischaemic region in conjunction with heart failure, which was more common in the AF patients. Other findings supporting an atherothrombotic mechanism were: the prevalence of AF was higher (19-29%) in all kinds of stroke, including haemorrhage, than in age-matched controls (3-9%). Also patients with previous AF and no present embolic source resembled the whole AF group and differed from patients with sinus rhythm. Thus embolism is a plausible cause of stroke in many AF patients, whereas an atherothrombotic origin is more likely in others. Characteristics identifying the mechanism in an individual case were not found. Stroke Vol 16, No 2, 1985 ATRIAL FIBRILLATION (AF) is one of the main risk factors for stroke. In unselected materials 21-25% of the patients with stroke have this arrhythmia.'-2 The Framingham study showed a nearly six times higher incidence of stroke in patients with AF due to ischaemic heart disease than in an age-, sex-, and blood pressure-matched control group without AF. The reason for an increased stroke risk in AF has always been claimed to be the occurrence of left atrial thrombosis causing arterial embolism. In patients with rheumatic heart disease, especially mitral stenosis with AF, the frequency of atrial thrombi has been found to be 30-42%. 4~6 However, this aetiology of AF is nowadays uncommon in industrialized countries and the prevalence of left atrial thrombi in non-rheumatic AF, although higher than in controls, is not more than 13-27%/. s, 7,8 ^j s o ^ a c t u a i existence of embolism in stroke cases can rarely be proved either in vivo or post mortem. Consequently it seems that other explanations than embolism for the association between AF and stroke must be considered. For example, generalized arteriosclerosis might be the common cause of both conditions. If this was the case, one would expect brain infarction in AF to resemble other atherothrombotic infarctions. Differences in patient or brain lesion characteristics, on the other hand, might suggest different pathogenetic mechanisms. To elucidate this problem the following questions were studied in an unselected stroke material: What is the prevalence of AF in different types of stroke? Are there any differences in risk factors or arteriosclerotic manifestations between brain infarction patients with and wit...
Objective-To assess the potential effects of primary prevention with anticoagulants or aspirin in atrial fibrillation on Swedish population.Design-Analysis of cost effectiveness based on the following assumptions: about 83000 people have atrial fibrillation in Sweden, of whom 22 000 would be potential candidates for treatment with anticoagulants and 55 000 for aspirin treatment; the annual 50/o stroke rate is reduced by 64% (with anticoagulants) and 25% (with aspirin
Arbin, M. von, Britton, M., Faire, U. de & Gustafsson, P. Non invasive assessment of the internal carotid artery in stroke patients. Scand. J . clin. Lab. Invest. 43, 275-283, 1983.The internal carotid arteries were evaluated with Doppler ultrasound technique in patients with acute cerebrovascular disease. The results of the Doppler examination of 325 vessels were compared to presence of carotid bruits on auscultation. In 126 arteries the findings were also compared with those on aortocervical, single carotid or post-mortal angiography.The Doppler flow reaction was normal in 74 % of the vessels, uncertain in 20 % and pathologic in 6 % . The sensitivity of the Doppler assessment in finding stenosis of more than 75% lumen diameter reduction was 85% with a specificity of 94%. The specificity increased with higher degree of vascular stenosis.Carotid bruits were heard in 34 arteries. The sensitivity of auscultation in detecting stenosis 75% was 47% with a specificity of 83%. The sensitivity fell with higher degree of stenosis.The Doppler procedure is a valuable tool indetectinglhaemodynamically significant stenoses in the internal carotid artery. The method could serve the following purposes in the clinical situation: 1. Screening procedure for further investigations in TIA and minor stroke patients fit enough to be candidates for vascular surgery. 2. Before blood-pressure can be safely reduced in patients with cerebrovascular disease. 3. For evaluation of the arteriosclerotic process in strokepatients thereby improving prognostication.For many years it has been believed that arteriosclerotic changes in the internal carotid arteries constitute a source for embolism or 0036-5513/83/0600-0275 $02.00 @ 1983 Medisinsk Fysiologisk Forenings Forlag reduced blood flow causing cerebral ischaemia [7, 9, 151. Since the first successful operations of the extracranial internal carotid artery had been performed in the fifties [6] methods for detecting operable arteriosclerotic lesions have developed rapidly. 275 Scand J Clin Lab Invest Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only. Scand J Clin Lab Invest Downloaded from informahealthcare.com by McMaster University on 11/17/14 For personal use only. Scand J Clin Lab Invest Downloaded from informahealthcare.com by McMaster University on 11/17/14For personal use only.
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