medigraphic.com
ISSN 2225-4676 (Electronic)

2020, Number 1

<< Back Next >>

Rev Cubana Neurol Neurocir 2020; 10 (1)

In-hospital cardioembolic stroke

Morales CE, Bustamante SA, Álvarez ED, Martín MG, Paz SL

Language: Spanish
References: 45
Page: 1-23
PDF size: 420.96 Kb.


ABSTRACT

Objective: To characterize the in-hospital occurrence of cardioembolic cerebral infarction.
Methods: An observational, descriptive, prospective study was carried out at Dr. Carlos J. Finlay Central Military Hospital from January 2016 to December 2017. Sixty-three patients suffering from cardioembolic stroke. The variables analyzed were age, sex, vascular risk factors, latency at admission, stroke severity, affected vascular territory, imaging size of cerebral infarction, therapeutic management, complications, state at discharge, hospital stay and Barthel scale at discharge. Descriptive statistics was used and absolute and relative frequencies of each variable were obtained.
Results: Among the vascular risk factors, the male sex (52.4%), those older than 70 years (63.8%), hypertension (87.3%) and nonvalvular atrial fibrillation (71.5%) predominated. Late care, involvement of the carotid territory, median infarct size on neuroimaging, mild stroke, short in-hospital stay, and non-neurological complications were more frequent. More than half received late-onset dual antiplatelet therapy and 41% did not anticoagulate on discharge from hospital.
Conclusions: Male patients, older than 70 years, with non-valvular atrial fibrillation, both chronic and isolated, and with congestive heart failure predominated. Most of these patients received late hospital care, so dual platelet antiaggregation was decided in the acute phase and non-anticoagulation at the time of hospital discharge.


REFERENCES

  1. 1.Wepfer JJ. Observations anatomicae, ex cadaveribus eorum, quos sustulit apoplexia, cum exercitatione de ejus loco affecto. Schaffhausen: Joh. Caspari Suteri; 1658.

  2. Kamel H, Healey JS. Cardioembolic Stroke. Circ Res. 2017;120(3):514-26.

  3. Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ Res. 2017;120(3):439-48.

  4. Ministerio de Salud Pública. Anuario estadístico de salud 2016. Anuario estadístico. 2016 [citado: 27/06/2018]; Disponible en: https://files.sld.cu/dne/files/2017/05/Anuario_Estad%25C3%25ADstico_de_Salud_e_2016_edici%25C3%25B3n_2017.pdf

  5. O’Carroll CB, Barrett KM. Cardioembolic Stroke. Continuum. 2017;23(1):111-32.

  6. Widimsky P, Doehner W, Diener HC, Van Gelder IC, Halliday A, Mazighi M, et al. The role of cardiologists in stroke prevention and treatment: position paper of the European Society of Cardiology Council on Stroke. Eur Heart J. 2018;39(17):1567-73.

  7. Sánchez AL, García JG, Ayo OM, Hernández F F, Díaz IM, Fernández ED, et al. ¿Se ha producido un cambio en la etiología del ictus isquémico en las últimas décadas? Análisis y comparación de una base de datos de ictus actual frente a las históricas. Neurología. 2018;33(6):369-77. DOI: 10.10.1016/j.nrl.2016.07.003

  8. Tsivgoulis G, Patousi A, Pikilidou M, Birbilis T, Katsanos AH, Mantatzis M, et.al. Stroke Incidence and Outcomes in Northeastern Greece The Evros Stroke Registry. Stroke. 2018;49(2):288-95.

  9. Leyden JM, Kleinig TJ, Newbury J, Castle S, Cranefield J, Anderson CS, et al. Adelaide stroke incidence study: declining stroke rates but many preventable cardioembolic strokes. Stroke. 2013;44(5):1226-31.

  10. Celeste F, Muratori M, Mapelli M, Pepi M. The Evolving Role and Use of Echocardiography in the Evaluation of Cardiac Source of Embolism. J Cardiovasc Echogr. 2017;27(2):33-44.

  11. Sousa JA, Mafalda MP, Silva F, Macario C. Cerebrovascular Dissemination in Time and Space as a Predictor of Cardioembolism. J Stroke Cerebrovasc Dis. 2017;26(7):1407-13.

  12. Bogiatzi C, Hackam D, McLeod A, Spence J. Secular trends in ischemic stroke subtypes and stroke risk factors. Stroke. 2014;45:3208-13.

  13. Guzmán JD. Ictus cardioembólico: epidemiología. Neurología. 2012;27(Supl 1):4-9.

  14. Álvarez Expósito D. Factores pronóstico en el Infarto cerebral Cardioembólico. Hospital “Clínico Quirúrgico Manuel Ascunce Domenech”. [Tesis para optar por el Título de Especialista de I Grado en Neurología] Camagüey: Universidad de Ciencias Médicas; 2013.

  15. Terroba Chambi CJ, Scherle Matamoros CE. Beneficios de la anticoagulación oral en pacientes con ictus cardioembólico por fibrilación auricular no valvular. Neurol Arg. 2013;5(3):158-63.

  16. Arboix A, Alio J. Acute cardioembolic cerebral infarction: answers to clinical questions. Curr Cardiol Rev. 2012;8(1):54-67.

  17. Ferro JM. Cardioembolic stroke: an update. Lancet Neurol. 2003;2(3):177-88.

  18. Jerjes Sánchez C, Cantú Brito C, Arauz A, Sánchez A, Zárate J, Riveray A. Guías para Anticoagulación y Trombolisis del Tromboembolismo Venoso, Infarto con Elevación del ST, Cardioembolismo Cerebral y del Infarto Cerebral Agudo. Arch Cardiol Mex. 2017;87(1):1-66.

  19. Lyden P, Brott T, Tilley B, Welch KM, Mascha EJ, Levine S, et al. Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group. Stroke. 1994;25(11):2220-6.

  20. Mahoney PL, Barthel DW. Functional evaluation: the Barthel index. Md St Med J. 1965;14:61-5.

  21. León FC. Pautas éticas internacionales para la investigación biomédica en seres humanos del Consejo de Organizaciones Internacionales de las Ciencias Médicas (CIOMS). Acta Bioethic, Chile. 2004;X(1):105-6.

  22. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e228-92.

  23. Vázquez Muñoz E, Gómez Cerezo J, Fernández Pavón A. Factores de riesgo de un nuevo accidente cerebral cardioembólico en la fibrilación auricular no valvular tratada con acenocumarol. Aten Primaria. 2001;28(1):46-9.

  24. Handan Cemille M, Havva Tugba Y, Serife Nese E, Elvan Cevizci A. Frequency of left atrial dilatation in ischemic stroke. North Clin Istanb. 2015;2(1):7-12.

  25. Arboix A, Massons J, García-Eroles L, Targa C, Parra O, Oliveres M. Trends in clinical features and early outcome in patients with acute cardioembolic stroke subtype over a 19-year period. Neurol India. 2012;60(3):288-93.

  26. Zecca B, Mandelli C, Maino A, Casiraghi C, Bolla G, Consonni D, et al. A Bioclinical Pattern for the Early Diagnosis of Cardioembolic Stroke. Emergency Medicine International. 2014;2014:242171.

  27. Choi YR, Kim HL, Kwon HM, Chun EJ, Ko SM, Yoo SM, et al. Cardiac CT and MRI for Assessment of Cardioembolic Stroke. Cardiovascular Imaging Asia. 2017;1(1):13.

  28. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837-47.

  29. Henninger N, Goddeau RP, Karmarkar A, Helenius J, McManus DD. Atrial Fibrillation Is Associated with a Worse 90-Day Outcome Than Other Cardioembolic Stroke Subtypes. Stroke. 2016;47(6):1486-92.

  30. Gokcal E, Pasi M, Fisher M, Gurol ME. Atrial Fibrillation for the Neurologist: Preventing both Ischemic and Hemorrhagic Strokes. Curr Neurol Neurosci Rep. 2018;18(2):6.

  31. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. Guía ESC 2016 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración con la EACTS. Rev Esp Cardiol. 2017;70(1):22-8.

  32. Rodríguez AJL, Pila RP, Pila RP, Vargas ÁRR. Factores determinantes del pronóstico en el ictus isquémico. Revista Archivo Médico de Camagüey. 2005;9(2):24-37.

  33. Cantú-Brito C, Ruiz-Sandoval J, Murillo-Bonilla L, Chiquete E, León Jiménez C, Arauz A. Manejo agudo y pronóstico a un año en pacientes mexicanos con un primer infarto cerebral: resultados del estudio multicéntrico PREMIER. Rev Neurol. 2010;51(11):641-9.

  34. Ortiz HB. Infarto de la arteria cerebral posterior secundario a oclusión aguda de la arteria carótida interna. Acta Neurol Colomb. 2015;31(1):49-53.

  35. Durá Mata MJ, Molleda Marzo M, García Almazán C, Mallol Badellino J, Calderon Padilla V. Factores pronósticos en el ictus. De la fase aguda a los tres años. Rehabilitación (Madr). 2011;45(1):18-23.

  36. Ruiz GP, Verdecía AT, Pérez YV, Brito GC. Mortalidad en la enfermedad cerebrovascular en el Hospital General Docente «Enrique Cabrera», La Habana. Rev. Urug. Enferm. 2017;12(1):47-58.

  37. Liu C, Shi F, Chen Z, Yan S, Ding X, Lou M. Severe Blood-Brain Barrier Disruption in Cardioembolic Stroke. Front Neurol. 2018;9:55. DOI: 10.3389/fneur.2018.00055

  38. Paciaroni M, Agnelli G, Corea F, Ageno W, Alberti A, Lanari A, et al. Early hemorrhagic transformation of brain infarction: rate, predictive factors, and influence on clinical outcome: results of a prospective multicenter study. Stroke. 2008;39(8):2249-56.

  39. Spence JD. Cardioembolic stroke: everything has changed. Stroke and Vascular Neurology. 2018;3(2):76-83.

  40. Morady F, Zipes DP. Fibrilación auricular: manifestaciones clínicas, mecanismos y tratamiento. Cap. 38. En: Mann D, Zipes D, Libby P, Bonow R. Tratado de cardiología. Braunwald. 10. ed. España: Elsevier Health Sciences; 2016. p.798-806.

  41. England TJ, Bath PMW, Sare GM, Geeganage C, Moulin T, O’Neill D, et al. Asymptomatic hemorrhagic transformation of infarction and its relationship with functional outcome and stroke subtype: assessment from the Tinzaparin in Acute Ischaemic Stroke Trial. Stroke. 2010;41(12):2834-9.

  42. Wang Y, Zhao X, Lin J, Li H, Johnston SC, Lin Y, et al. Association Between CYP2C19 Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients with Minor Stroke or Transient Ischemic Attack. JAMA. 2016;316(1):70-8.

  43. Gladstone DJ, Bui E, Fang J, Laupacis A, Lindsay MP, Tu JV, et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke. 2009;40(1):235-40.

  44. Benavente L, Calleja S, de la Vega V, García J, Lahoz CH. Oral anticoagulation in elderly patients as secondary prevention of cardioembolic strokes. Int Arch Med. 2010;3:8.

  45. Palm F, Kraus M, Safer A, Wolf J, Becher H, Grau AJ. Management of oral anticoagulation after cardioembolic stroke and stroke survival data from a population based stroke registry (LuSSt). BMC Neurol. 2014;14:199.




2020     |     www.medigraphic.com