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Erschienen in: InFo Neurologie + Psychiatrie 4/2013

03.05.2013 | Apoplex | zertifizierte fortbildung

Emboliequelle identifizieren, Akuttherapie einleiten, Rezidiven vorbeugen

Kardioembolischer Schlaganfall

verfasst von: Dr. med. Daniel Müller, Hans-Christoph Diener, Karim Hajjar, Björn Plicht, Thomas Buck, Christian Weimar

Erschienen in: InFo Neurologie + Psychiatrie | Ausgabe 4/2013

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Kardioembolische Schlaganfälle sind die ischämischen Schlaganfälle mit der höchsten Mortalitätsrate und oft mit erheblichen Behinderungen assoziiert. Aufgrund der Neigung zu kurz- und langfristigen Rezidiven ist die Identifizierung einer kardialen Emboliequelle und die adäquate Therapieeinleitung essenziell.

  1. Palacio, S. and R.G. Hart, Neurologic manifestations of cardiogenic embolism: an update. Neurol Clin, 2002. 20(1): p. 179–93, vii.PubMedView Article
  2. Bogousslavsky, J., et al., Cardiac sources of embolism and cerebral infarction-clinical consequences and vascular concomitants: the Lausanne Stroke Registry. Neurology, 1991. 41(6): p. 855–9.PubMedView Article
  3. Cardiogenic brain embolism. The second report of the Cerebral Embolism Task Force. Arch Neurol, 1989. 46(7): p. 727-43.
  4. Arboix, A., et al., Predictive clinical factors of in-hospital mortality in 231 consecutive patients with cardioembolic cerebral infarction.Cerebrovasc Dis, 1998. 8(1): p. 8–13.PubMedView Article
  5. Arboix, A. and J. Alio, Acute cardioembolic cerebral infarction: answers to clinical questions. Curr Cardiol Rev, 2012. 8(1): p. 54–67.PubMedView Article
  6. Hanlon, R.E., W.E. Lux, and A.W. Dromerick, Global aphasia without hemiparesis: language profiles and lesion distribution. J Neurol Neurosurg Psychiatry, 1999. 66(3): p. 365–9.PubMedView Article
  7. Arboix, A., et al., Early differentiation of cardioembolic from atherothrombotic cerebral infarction: a multivariate analysis. Eur J Neurol, 1999. 6(6): p. 677–83.PubMedView Article
  8. Hart, R.G., Cardiogenic embolism to the brain. Lancet, 1992. 339(8793): p. 589–94.PubMedView Article
  9. Wessels, T., et al., Identification of embolic stroke patterns by diffusion-weighted MRI in clinically defined lacunar stroke syndromes. Stroke, 2005. 36(4): p. 757–61.PubMedView Article
  10. Wlodek, A., et al., Agreement between the clinical Oxfordshire Community Stroke Project classification and CT findings in Poland. Eur J Neurol, 2004. 11(2): p. 91–6.PubMedView Article
  11. Jorgensen, L. and A. Torvik, Ischaemic cerebrovascular diseases in an autopsy series. 2. Prevalence, location, pathogenesis, and clinical course of cerebral infarcts. J Neurol Sci, 1969. 9(2): p. 285–320.View Article
  12. Fisher, M. and R.D. Adams, Observations on brain embolism with special reference to the mechanism of hemorrhagic infarction. J Neuropathol Exp Neurol, 1951. 10(1): p. 92–4.PubMed
  13. Bogousslavsky, J., et al., Early spontaneous hematoma in cerebral infarct: is primary cerebral hemorrhage overdiagnosed? Neurology, 1991. 41(6): p. 837–40.PubMedView Article
  14. Batista, P., V. Oliveira, and J.M. Ferro, The detection of microembolic signals in patients at risk of recurrent cardioembolic stroke: possible therapeutic relevance. Cerebrovasc Dis, 1999. 9(6): p. 314–9.PubMedView Article
  15. Gaillard, N., et al., Detection of paroxysmal atrial fibrillation with transtelephonic EKG in TIA or stroke patients. Neurology, 2010. 74(21): p. 1666–70.PubMedView Article
  16. Morris, J.G., E.J. Duffis, and M. Fisher, Cardiac workup of ischemic stroke: can we improve our diagnostic yield? Stroke, 2009. 40(8): p. 2893–8.PubMedView Article
  17. Sinha, A.M., et al., Cryptogenic Stroke and underlying Atrial Fibrillation (CRYSTAL AF): design and rationale. Am Heart J, 2010. 160(1): p. 36–41 e1.PubMedView Article
  18. Douglas, P.S., et al., ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appro-priate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. J Am Soc Echocardiogr, 2011. 24(3): p. 229–67.PubMedView Article
  19. Reynolds, H.R., P.A. Tunick, and I. Kronzon, Role of transesophageal echo-cardiography in the evaluation of patients with stroke. Curr Opin Cardiol, 2003. 18(5): p. 340–5.PubMedView Article
  20. Mas, J.L., et al., Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med, 2001. 345(24): p. 1740–6.PubMedView Article
  21. Homma, S., et al., Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation, 2002. 105(22): p. 2625–31.View Article
  22. Furlan, A.J., et al., Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med, 2012. 366(11): p. 991–9.PubMedView Article
  23. Amarenco, P., et al., The prevalence of ulcerated plaques in the aortic arch in patients with stroke. N Engl J Med, 1992. 326(4): p. 221–5.PubMedView Article
  24. Tunick, P.A., J.L. Perez, and I. Kronzon, Protruding atheromas in the thoracic aorta and systemic embolization. Ann Intern Med, 1991. 115(6): p. 423–7.PubMedView Article
  25. Jones, E.F., et al., Proximal aortic atheroma. An independent risk factor for cerebral ischemia. Stroke, 1995. 26(2): p. 218–24.PubMed
  26. Di Tullio, M.R., et al., Aortic atheromas and acute ischemic stroke: a transe-sophageal echocardiographic study in an ethnically mixed population. Neurology, 1996. 46(6): p. 1560–6.PubMedView Article
  27. Di Tullio, M.R., et al., Aortic atheroma morphology and the risk of ischemic stroke in a multiethnic population. Am Heart J, 2000. 139(2 Pt 1): p. 329–36.PubMed
  28. Amarenco, P., et al., Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med, 1994. 331(22): p. 1474–9.PubMedView Article
  29. Blackshear, J.L., et al., Aortic plaque in atrial fibrillation: prevalence, predictors, and thromboembolic implications. Stroke, 1999. 30(4): p. 834–40.PubMedView Article
  30. Sen, S., et al., Distribution, severity and risk factors for aortic atherosclerosis in cerebral ischemia. Cerebrovasc Dis, 2000. 10(2): p. 102–9.PubMedView Article
  31. Meissner, I., et al., Atherosclerosis of the aorta: risk factor, risk marker, or innocent bystander? A prospective population-based transesophageal echocardiography study. J Am Coll Cardiol, 2004. 44(5): p. 1018–24.PubMedView Article
  32. Ferrari, E., et al., Atherosclerosis of the thoracic aorta and aortic debris as a marker of poor prognosis: benefit of oral anticoagulants. J Am Coll Cardiol, 1999. 33(5): p. 1317–22.PubMedView Article
  33. Pujadas, R., et al., [Role of complex aortic atheroma plaques in the recurrence of unexplained cerebral infarction]. Rev Esp Cardiol, 2005. 58(1): p. 34–40.PubMedView Article
  34. Tunick, P.A., et al., Effect of treatment on the incidence of stroke and other emboli in 519 patients with severe thoracic aortic plaque. Am J Cardiol, 2002. 90(12): p. 1320–5.PubMedView Article
  35. Lima, J.A., et al., Statin-induced cholesterol lowering and plaque regression after 6 months of magnetic resonance imaging-monitored therapy. Circulation, 2004. 110(16): p. 2336–41.PubMedView Article
  36. Capmany, R.P., M.O. Ibanez, and X.J. Pesquer, Complex atheromatosis of the aortic arch in cerebral infarction. Curr Cardiol Rev, 2010. 6(3): p. 184–93.PubMedView Article
  37. Arko, F.R., et al., Mobile atheroma of the aortic arch and the risk of carotid artery disease. Am J Surg, 1999. 178(3): p. 206–8.PubMedView Article
  38. Stern, A., et al., Protruding aortic arch atheromas: risk of stroke during heart surgery with and without aortic arch endarterectomy. Am Heart J, 1999. 138(4 Pt 1): p. 746–52.PubMedView Article
  39. Cabell, C.H., et al., The risk of stroke and death in patients with aortic and mitral valve endocarditis. Am Heart J, 2001. 142(1): p. 75–80.PubMedView Article
  40. Heinle, S., et al., Value of transthoracic echocardiography in predicting embolic events in active infective endocarditis. Duke Endocarditis Service. Am J Cardiol, 1994. 74(8): p. 799–801.PubMedView Article
  41. Tischler, M.D. and P.T. Vaitkus, The ability of vegetation size on echocardiography to predict clinical complications: a meta-analysis. J Am Soc Echocardiogr, 1997. 10(5): p. 562–8.PubMedView Article
  42. Vaitkus, P.T. and E.S. Barnathan, Embolic potential, prevention and manage-ment of mural thrombus complicating anterior myocardial infarction: a meta-analysis. J Am Coll Cardiol, 1993. 22(4): p. 1004–9.PubMedView Article
  43. Kushner, F.G., et al., 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 fo-cused update) a report of the American College of Cardiology Founda-tion/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2009. 54(23): p. 2205–41.PubMedView Article
  44. Furie, K.L., et al., Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke, 2011. 42(1): p. 227–76.PubMedView Article
  45. Witt, B.J., et al., The incidence of ischemic stroke in chronic heart failure: a metaanalysis. J Card Fail, 2007. 13(6): p. 489–96.PubMedView Article
  46. Wolf, P.A., R.D. Abbott, and W.B. Kannel, Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke, 1991. 22(8): p. 983–8.PubMedView Article
  47. Loh, E., et al., Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med, 1997. 336(4): p. 251–7.PubMedView Article
  48. Jafri, S.M., Hypercoagulability in heart failure. Semin Thromb Hemost, 1997. 23(6): p. 543–5.PubMedView Article
  49. Sbarouni, E., et al., Relationship between hemostatic abnormalities and neuroendocrine activity in heart failure. Am Heart J, 1994. 127(3): p. 607–12.PubMedView Article
  50. Homma, S., et al., Warfarin and aspirin in patients with heart failure and sinus rhythm. N Engl J Med, 2012. 366(20): p. 1859–69.PubMedView Article
  51. Bonow, R.O., et al., 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular An-giography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2008. 52(13): p. e1–142.PubMedView Article
  52. Acar, J., et al., AREVA: multicenter randomized comparison of low-dose versus standard-dose anticoagulation in patients with mechanical prosthetic heart valves. Circulation, 1996. 94(9): p. 2107–12.PubMedView Article
  53. Weir, N.U., An update on cardioembolic stroke. Postgrad Med J, 2008. 84(989): p. 133–42; quiz 139-40.PubMedView Article
  54. Mahajan, R., et al., Importance of the underlying substrate in determining thrombus location in atrial fibrillation: implications for left atrial appendage closure. Heart, 2012. 98(15): p. 1120–6.PubMedView Article
  55. Holmes, D.R., et al., Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet, 2009. 374(9689): p. 534–42.PubMedView Article
  56. Reddy, V.Y., et al., Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry. Circulation, 2011. 123(4): p. 417–24.PubMedView Article
  57. Park, J.W., et al., Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience. Catheter Cardiovasc Interv, 2011. 77(5): p. 700–6.View Article
  58. Plicht, B., et al., Thrombus formation on the new Amplatzer Cardiac Plug after LAA occlusion - a word of caution. Clin Res Cardiol., 2011. 100(Suppl 1)(V905 (ABSTRACT)).
  59. Lopez-Minguez, J.R., et al., Immediate and One-year Results in 35 Consecutive Patients After Closure of Left Atrial Appendage With the Amplatzer Car-diac Plug. Rev Esp Cardiol.
  60. Frank, B., et al., Impact of atrial fibrillation on outcome in thrombolyzed patients with stroke: evidence from the Virtual International Stroke Trials Archive (VISTA). Stroke, 2012. 43(7): p. 1872–7.PubMedView Article
  61. Douxfils, J., et al., Impact of dabigatran on a large panel of routine or specific coagulation assays. Laboratory recommendations for monitoring of dabigatran etexilate. Thromb Haemost, 2012. 107(5): p. 985–97.PubMedView Article
  62. Harenberg, J. and R. Kraemer, Measurement of the new anticoagulants. Thromb Res, 2012. 129 Suppl 1: p. S106–13.PubMedView Article
  63. Steiner, T., Neue direkte Orale Antikoagulanzien: Was im Notfall zu beachten ist. Dtsch Arztebl, 2012. 39: p. A–1928 / B-1570 / C-1542 2012;109:A-1928 / B-1570 / C-1542.
  64. Hart, R.G., L.A. Pearce, and M.I. Aguilar, Metaanalysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med, 2007. 146(12): p. 857–67.PubMedView Article
  65. Mant, J., et al., Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet, 2007. 370(9586): p. 493–503.PubMedView Article
  66. Diener, H.C. and C. Weimar, Leitlinien für Diagnostik und Therapie in der Neurologie. 2012, Stuttgart, New York: Georg Thieme Verlag.
  67. Connolly, S.J., et al., Apixaban in patients with atrial fibrillation. N Engl J Med, 2011. 364(9): p. 806–17.PubMedView Article
  68. Paciaroni, M., et al., Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a metaanalysis of randomized controlled trials. Stroke, 2007. 38(2): p. 423–30.PubMedView Article
  69. Pisters, R., et al., A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest, 2010. 138(5): p. 1093–100.PubMedView Article
  70. LaHaye, S.A., et al., A clinical decision aid for the selection of antithrombotic therapy for the prevention of stroke due to atrial fibrillation. Eur Heart J, 2012. 33(17): p. 2163–71.PubMedView Article
Emboliequelle identifizieren, Akuttherapie einleiten, Rezidiven vorbeugen
Kardioembolischer Schlaganfall
verfasst von
Dr. med. Daniel Müller
Hans-Christoph Diener
Karim Hajjar
Björn Plicht
Thomas Buck
Christian Weimar
Urban and Vogel
Erschienen in
InFo Neurologie + Psychiatrie / Ausgabe 4/2013
Print ISSN: 1437-062X
Elektronische ISSN: 2195-5166

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