Updates on Prevention of Cardioembolic Strokes

Abstract

Cardiac embolism continues to be a leading etiology of ischemic strokes worldwide. Although pathologies that result in cardioembolism have not changed over the past decade, there have been significant advances in the treatment and stroke prevention methods for these conditions. Atrial fibrillation remains the prototypical cause of cardioembolic strokes. The availability of new long-term monitoring devices for atrial fibrillation detection such as insertable cardiac monitors has allowed accurate detection of this leading cause of cardioembolism. The non-vitamin K antagonist oral anticoagulants have improved our ability to prevent strokes for many patients with non-valvular atrial fibrillation (NVAF). Advances in left atrial appendage closure and the U.S. Food and Drug Administration approval of the WATCHMAN (Boston Scientific) device for stroke prevention in NVAF patients who have an appropriate rationale for a nonpharmacological alternative, have revolutionized the field and provided a viable option for patients at higher hemorrhagic risk. The role of patent foramen ovale closure for secondary prevention in selected patients experiencing cryptogenic ischemic strokes at a relatively young age has become clearer thanks to the very recent publication of long-term outcomes from three major studies. Advances in the management of infective endocarditis, heart failure, valvular diseases, and coronary artery disease have significantly changed the management of such patients, but have also revealed new concerns related to assessment of ischemic versus hemorrhagic risk in the setting of antithrombotic use. The current review article aims to discuss these advances especially as they pertain to the stroke neurology practice.

Modeling blood–brain barrier pathology in cerebrovascular disease in vitro: current and future paradigms

“…The basic principle is to establish the BBB in artificial microvessels, achieved by growing BEC in the lumen of coated channels to form a microstructure with inclusion of perivascular cells (astrocytes, pericytes) on the outer side of the channels. The 3D platforms (BBB -on-a-chip) are broadly categorized into three groups: [1] dynamic in vitro BBB model (DIV-BBB), [2] microfluidic BBB (μBBB) [3] BBB-on-a-chip.…”

Updates on Prevention of Hemorrhagic and Lacunar Strokes

“…Nonpharmacological approaches, such as left atrial appendage closure, might provide potential alternatives to life-long anticoagulation for non-valvular atrial fibrillation and are further discussed in an accompanying review article in this issue of the Journal of Stroke as well as in a separate recent review [ 63 , 77 ]. In acute myocardial infarction and deep venous thrombosis, anticoagulation time should be minimized to the lowest extent possible if the patient has cSVD.…”

Percutaneous Left Atrial Appendage Occlusion for the Prevention of Stroke in Patients with Atrial Fibrillation: Review and Critical Appraisal

“…Figure 1 taken from Topcuoglu et al [ 22 ] in 2018 illustrates some of the devices and their anatomical relation to the LAA.…”

“…Devices are trademarks of their respective companies, all rights reserved. Adapted from Topcuoglu et al[ 22 ]…”