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Review
. 2024 May 26;25(11):5777.
doi: 10.3390/ijms25115777.

Cardioembolic Stroke: Past Advancements, Current Challenges, and Future Directions

Yuji Kato  1 , Kenta Tsutsui  2   3 , Shintaro Nakano  2 , Takeshi Hayashi  1 , Satoshi Suda  1
Affiliations
Review

Cardioembolic Stroke: Past Advancements, Current Challenges, and Future Directions

Yuji Kato et al. Int J Mol Sci. .

Abstract

Cardioembolic stroke accounts for over 20% of ischemic strokes and is associated with worse outcomes than other types of strokes. Atrial fibrillation (AF) is the most common risk factor for cardioembolic stroke. In this narrative review, we present an update about cardioembolic stroke mainly related to AF and atrial cardiopathy. Direct oral anticoagulants (DOACs) have revolutionized stroke prevention in patients with AF; however, their efficacy in preventing recurrent embolic stroke of unknown source remains uncertain. Various cardiac monitoring methods are used to detect AF, which is crucial for preventing stroke recurrence. DOACs are preferred over warfarin for AF-related stroke prevention; however, the timing of initiation after acute ischemic stroke is debated. Resuming anticoagulation after intracerebral hemorrhage in AF patients requires careful assessment of the risks. While catheter ablation may reduce the incidence of cardiovascular events, its effect on stroke prevention is unclear, especially in heart failure patients. Atrial cardiopathy is the emerging cause of embolic stroke of unknown source, which indicates atrial structural and functional disorders that can precede AF. Future research should focus on refining stroke risk prediction models, optimizing AF detection, understanding the roles of ablation and anticoagulation in stroke prevention, and establishing atrial cardiopathy as a therapeutic target, which could significantly reduce the burden of stroke.

Keywords: atrial cardiopathy; atrial fibrillation; direct oral anticoagulants; embolic stroke of unknown source.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Heart diseases associated with stroke. Diseases associated with a high risk of stroke are shown in red text; green text indicates low or uncertain risk. EF, ejection fraction.
Figure 2
Figure 2
Patient management is based on risk of stroke and presence of atrial fibrillation.
Figure 3
Figure 3
Atrial cardiopathy as a stroke risk factor. The causes of thromboembolic stroke include atrial fibrillation as well as atrial cardiopathy, which is caused by underlying changes in the atrial tissue that occur as a result of stretching and enlargement. Atrial cardiopathy in conjunction with an irregular heart rhythm exacerbates the tissue changes and impairs left atrial contraction, which increases the risk of thromboembolic stroke. Once stroke occurs, autonomic and inflammatory changes in the atrium may transiently increase the risk of atrial fibrillation.
See this image and copyright information in PMC

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