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Romanenko A.V.

Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Solovieva E.Yu.

Pirogov Russian National Research Medical University

Pathogenetic and therapeutic aspects of cardioembolic stroke

Authors:

Romanenko A.V., Solovieva E.Yu.

More about the authors

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To cite this article:

Romanenko AV, Solovieva EYu. Pathogenetic and therapeutic aspects of cardioembolic stroke. S.S. Korsakov Journal of Neurology and Psychiatry. 2021;121(3):165‑172. (In Russ.)
https://doi.org/10.17116/jnevro2021121031165

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References:

  1. Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):259-281.  https://doi.org/10.1016/S2214-109X(13)70089-5
  2. Klinicheskie rekomendatsii: Ishemicheskii insul’t i tranzitornaya ishemicheskaya ataka u vzroslykh. Natsional’naya assotsiatsiya po bor’be s insul’tom, Vserossiiskoe obshchestvo nevrologov, Assotsiatsiya neirokhirurgov Rossii MOO Ob’edinenie neiroanesteziologov i neiroreanimatologov, Soyuz reabilitologov Rossii. 2015;7-94. (In Russ.).
  3. Mukherjee D, Patil CG. Epidemiology and the global burden of stroke. World Neurosurg. 2011;76(6 suppl):85-90.  https://doi.org/10.1016/j.wneu.2011.07.023
  4. Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41.  https://doi.org/10.1161/01.str.24.1.35
  5. Heiss WD. Malignant MCA Infarction: Pathophysiology and Imaging for Early Diagnosis and Management Decisions. Cerebrovasc Dis. 2016;41(1-2):1-7.  https://doi.org/10.1159/000441627
  6. Babikian VL, Caplan LR. Brain embolism is a dynamic process with variable characteristics. Neurology. 2000;54(4):797-801.  https://doi.org/10.1212/wnl.54.4.797
  7. Shirokov EA. Stroke prevention: current problems and new trends. Russkii meditsinskii zhurnal. 2013;10:466-469. (In Russ.).
  8. Skvortsova VI, Evzel’man MA. Ishemicheskii insul’t. Orel. 2006. (In Russ.).
  9. Tibekina LM, Dorofeeva MS, Scherbuk YA. Cardioembolic stroke: etiology, pathogenesis, risk factors for hemorrhagictransformation. Vestnik Sankt-Peterburgskogo universiteta. Meditsina. 2014;1:104-117. (In Russ.).
  10. Minematsu K. Pathophysiology and prevention of cardiogenic brain embolism. Rinsho Shinkeigaku. 2000;40(12):1244-1246.
  11. Gorelick PB, Sacco RL, Smith DB, et al. Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA. 1999;281(12):1112-1120. https://doi.org/10.1001/jama.281.12.1112
  12. Damulin IV, Andreev DA, Salpagarova ZK. Cardioembolic stroke. Nevrologiya, Neiropsikhiatriya, Psikhosomatika. 2015;1:80-86 (In Russ.). https://doi.org/10.14412/2074-2711-2015-1-80-86
  13. Carbajo-García AM, Cortés J, Arboix A, et al. Predictive clinical features of cardioembolic infarction in patients aged 85 years and older. J Geriatr Cardiol. 2019;16(11):793-799. 
  14. Hanna JP, Furlan AJ. Cardiac Disease and Embolic Sources. In: Caplan LR, ed. Brain Ischemia. London: Springer-Verlag; 1995. https://doi.org/10.1007/978-1-4471-2073-5_31
  15. Cerebral Embolism Task Force. Cardiogenic Brain Embolism. Arch Neurology. 1986;43(1):71-84.  https://doi.org/10.1001/archneur.1986.00520010065026
  16. Vereshchagina NV, Piradova MA, Suslinoi ZA. Insul’t. Printsipy diagnostiki, lecheniya i profilaktiki. Kratkoe rukovodstvo dlya vrachei. M.: Intermedika; 2002. (In Russ.).
  17. Shevchenko YuL, Odinak AN, Kuznetsov AN, Erofeev AA. Kardiogennyy i angiogennyy tsere-bral’nyy embolicheskiy insul’t. M.: GEOTAR-Media; 2006. (In Russ.).
  18. Shevchenko YuL, Mikhailenko AA, Kuznetsov AN, Erofeev AA. Kardiokhirurgicheskaya agressiya i golovnoi mozg: Tserebral’naya gemodinamika i nevrologicheskie iskhody operatsii na serdtse. SPb.: Nauka; 1997. (In Russ.).
  19. Evtushenko SK. Vzaimootnoshenie kardionevrologii i neirokardiologii na klinicheskoi modeli kardioembolicheskogo insul’ta. Mizhnarodnii nevrologichnii zhurnal. 2010;6:7-16. (In Russ.).
  20. Kuznetsova SM. Sovremennye predstavleniya o kardioembolicheskom ishemicheskom insul’te. Zdorov’ya Ukraїni. 2012;6:34-35. (In Russ.).
  21. Gusev EI, Skvortsova VI. Ishemiya golovnogo mozga. M.: Meditsina; 2001. (In Russ.).
  22. Khenneritsi MG, Boguslavski Zh, Sakko RL; Skvortsova VI, per. s angl., ed. Insul’t: klinicheskoe rukovodstvo. 2-e izd. M.: MEDpress-inform; 2008. (In Russ.).
  23. Stakhovskoi LV, Kotova SV. Insul’t. Rukovodstvo dlya vrachei. M.: MIA; 2014. (In Russ.).
  24. Mezhdunarodnaya klassifikatsiya boleznei 10-go peresmotra (MKB-10) [Internet]. Accessed Mar 4, 2021. https://mkb-10.com/
  25. Arboix A, Oliveres M, Massons J, et al. Early differentiation of cardioembolic from atherothrombotic cerebral infarction: a multivariate analysis. Eur J Neurol. 1999;6(6):677-683.  https://doi.org/10.1046/j.1468-1331.1999.660677.x
  26. Ringelstein EB, Koschorke S, Holling A, et al. Computed tomographic patterns of proven embolic brain infarctions. Ann Neurol. 1989;26(6):759-765.  https://doi.org/10.1002/ana.410260612
  27. Suslina ZA, Piradov MA, eds. Insul’t: diagnostika, lechenie, profilaktika. 2-e izd. M.: MEDpressin-form; 2009. (In Russ.).
  28. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581-1587. https://doi.org/10.1056/NEJM199512143332401
  29. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018;49(3):46-110.  https://doi.org/10.1161/STR.0000000000000158
  30. IST-3 collaborative group. Effect of thrombolysis with alteplase within 6 h of acute ischaemic stroke on long-term outcomes (the third International Stroke Trial [IST-3]): 18-month follow-up of a randomised controlled trial. Lancet Neurol. 2013;12(8):768-776.  https://doi.org/10.1016/S1474-4422(13)70130-3
  31. Piradov MA, Domashenko MA, Maksimova MYu. Reperfuzionnye metody lecheniya ishemicheskogo insul’ta. In: Piradov MA, Illarioshkin SN, Tanashyan MM, eds. Nevrologiya XXI veka: diagnosticheskie, lechebnye i issledovatel’skie tekhnologii: rukovodstvo dlya vrachei. Vol. 2. Vysokotekhnologichnye metody lecheniya i reabilitatsii v nevrologii. M.: ATMO; 2015. (In Russ.).
  32. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384(9958):1929-1935. https://doi.org/10.1016/S0140-6736(14)60584-5
  33. Xian Y, Liang L, Smith EE, et al. Risks of intracranial hemorrhage among patients with acute ischemic stroke receiving warfarin and treated with intravenous tissue plasminogen activator. JAMA. 2012;307(24):2600-2608. https://doi.org/10.1001/jama.2012.6756
  34. Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581-641.  https://doi.org/10.1161/STR.0000000000000086
  35. Manoukian SV, Feit F, Mehran R, et al. Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes: an analysis from the ACUITY Trial. J Am Coll Cardiol. 2007;49(12):1362-1368. https://doi.org/10.1016/j.jacc.2007.02.027
  36. Kamel H, Johnston SC, Kirkham JC, et al. Association between major perioperative hemorrhage and stroke or Q-wave myocardial infarction. Circulation. 2012;126(2):207-212.  https://doi.org/10.1161/CIRCULATIONAHA.112.094326
  37. Goyal M, Menon BK, van Zwam WH., et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731. https://doi.org/10.1016/S0140-6736(16)00163-X
  38. Guseva EI, Konovalova AN, Skvortsova VI, Gekht AB, eds. Nevrologiya: natsional’noe rukovodstvo. M.: GEOTAR-Media; 2009. (In Russ.).
  39. European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457-507.  https://doi.org/10.1159/000131083
  40. Han H, Choi H, Cho KT, Kim BC. Mechanical Thrombectomy with Solitaire Stent Retrieval for Acute Cardioembolic Stroke. J Korean Neurosurg Soc. 2017;60(6):627-634.  https://doi.org/10.3340/jkns.2016.0707.003
  41. Aguilar MI, Hart R, Pearce LA. Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no history of stroke or transient ischemic attacks. Cochrane Database Syst Rev. 2007;3:CD006186. https://doi.org/10.1002/14651858.CD006186.pub2
  42. Cardiogenic brain embolism. The second report of the Cerebral Embolism Task Force. Arch Neurol. 1989;46(7):727-743. 
  43. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):78-140.  https://doi.org/10.1016/j.jacc.2012.11.019
  44. Weinsaft JW, Kim RJ, Ross M, et al. Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus. JACC Cardiovasc Imaging. 2009;2(8):969-979.  https://doi.org/10.1016/j.jcmg.2009.03.017
  45. Weinsaft JW, Kim J, Medicherla CB, et al. Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus: A Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR. JACC Cardiovasc Imaging. 2016;9(5):505-515.  https://doi.org/10.1016/j.jcmg.2015.06.017
  46. Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947.  https://doi.org/10.1161/STR.0b013e318284056a
  47. Furie KL, Kasner SE, Adams RJ, 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):227-276.  https://doi.org/10.1161/STR.0b013e3181f7d043
  48. Management of Stroke Rehabilitation Working Group. VA/DOD Clinical practice guideline for the management of stroke rehabilitation. J Rehabil Res Dev. 2010;47(9):1-43. 
  49. Management of patients with stroke or TIA: assessment, investigation, immediatemanagement and secondary prevention. A national clinical guideline. Scottish Intercollegiate Guidelines Network; 2008;108. 
  50. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983-988.  https://doi.org/10.1161/01.STR.22.8.983
  51. Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955-962.  https://doi.org/10.1016/S0140-6736(13)62343-0
  52. Connolly SJ, Eikelboom J, Joyner C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364(9):806-817.  https://doi.org/10.1056/NEJMoa1007432
  53. Pollack CV, Reilly PA, Eikelboom J, et al. Idarucizumab for Dabigatran Reversal. N Engl J Med. 2015;373(6):511-520.  https://doi.org/10.1056/NEJMoa1502000
  54. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-1151. https://doi.org/10.1056/NEJMoa0905561
  55. Eikelboom JW, Weitz JI. Anticoagulation therapy. Dabigatran and risk of myocardial infarction. Nat Rev Cardiol. 2012;9(5):260-262.  https://doi.org/10.1038/nrcardio.2012.34
  56. Morozova TE, Andrushchishina TB. Prevention of thromboembolism in patientswith atrial fibrillation. Farmateka. 2014;9:81-87. (In Russ.).
  57. Ashikhmin YaI, Shchekochikhin DYu. Individualized antithrombotic therapy in atrial fibrillation. Farmateka. 2013;18:119-123. (In Russ.).
  58. Kuznetsov AN, Vinogradov OI, Rybalko NV. Sovremennye podkhody k antitromboticheskoi terapii u bol’nykh s kardioembolicheskim insul’tom. Nevrologiya, neiropsikhiatriya, psikhosomatika. 2013;(S2):28-39. (In Russ.). https://doi.org/10.14412/2074-2711-2013-2356
  59. Walcott BP, Boehm KM, Stapleton CJ, et al. Retrievable stent thrombectomy in the treatment of acute ischemic stroke: analysis of a revolutionizing treatment technique. J Clin Neurosci. 2013;20(10):1346-1349. https://doi.org/10.1016/j.jocn.2013.03.015
  60. Parfenov VA, Khasanova DR. Ishemicheskiy insul’t. M.: MIA; 2012. (In Russ.).
  61. Parfenov VA. Profilaktika povtornogo ishemicheskogo insul’ta. Russkii meditsinskii zhurnal. 2008;16(12):1694-1699. (In Russ.).
  62. Kiprenskii YuV, Kadykov AS, Kiprenskii AYu, Shakhparonova NV, Shcherbakova IV, Pustovoitenko GV. Lechenie i profilaktika bol’nykh s kardioembolicheskim ishemicheskim insul’tom. Nevrologiya i revmatologiya. Prilozhenie k zhurnalu Consilium Medicum. 2014;1:33-38. (In Russ.).
  63. Suslova EY, Vakhnina NV. Management of patients in early recovery after stroke. Meditsinskiy sovet. 2014;18:6-11. (In Russ.).
  64. Zakharov VV, Vakhnina N.V. Osobennosti vedeniya patsientov s postinsul’tnymi kognitivnymi narusheniyami. Atmosfera. Nervnye bolezni. 2011;3:14-20. (In Russ.).
  65. Maksimova MYu, Tanashyan MM, Fedorova TN, Gur’yanova OE. Opyt primeneniya Mildronata pri ishemicheskom insul’te. Medica Mente. 2019;5(1):22-27. (In Russ.).
  66. Dambrova M, Liepinsh E, Kalvinsh I. Mildronate: cardioprotective action through carnitine-lowering effect. Trends Cardiovasc Med. 2002;12(6):275-279.  https://doi.org/10.1016/s1050-1738(02)00175-5
  67. Shutenko ZhV, Meirena DV, Kagan TI, et al. Mildronat: mekhanizmy deistviya, perspektiva korrektsii patologicheskikh sostoyanii. Khimichesko-farmatsevticheskii zhurnal. 1995;29(5):13-17. (In Russ.).
  68. Frantsuzova SB, Yatsetenko VP, Zotov AS, et al. Farmakodinamika mildronata: obzor. Zhurnal akademii meditsinskikh nauk Ukrainy. 1997;4:612-624. (In Russ.).
  69. Eninya GI, Timofeeva TN, Egere DA, Maiore IKh. Lechebnye effekty Mildronata i pokazaniya k ego primeneniyu v neiroangiologii. Eksperimental’naya i klinicheskaya farmakoterapiya. 1991;19:164-171. (In Russ.).
  70. Vinichuk SM. The efficacy of the mildronate treatment of patients with ischemic stroke. Vrachebnoe delo. 1991;7:77-79. (In Russ.).
  71. Abeuov BA, Raimkulov BN, Mitrokhin DA, et al. Sostoyanie vysshikh mozgovykh funktsii u bol’nykh s distsirkulyatornoi entsefalopatiei pri lechenii Mildronatom. Meditsina. 2004;2:78-81. (In Russ.).
  72. Dzyak LA, Golik VA. The Use of Mildronate in the treatment of patients with dyscirculatory encephalopathy on the background of stenosing lesions of the main arteries of the head. Vrachebnoe delo. 2003;(5-6):98-101. (In Russ.).
  73. Liepinsh E, Konrade I, Skapare E, et al. Mildronate treatment alters γ-butyrobetaine and l-carnitine concentrations in healthy volunteers. J Pharm Pharmacol. 2011;63(9):1195-1201. https://doi.org/10.1111/j.2042-7158.2011.01325.x
  74. Zvejniece L, Svalbe B, Makrecka M, et al. Mildronate exerts acute anticonvulsant and antihypnotic effects. Behav Pharmacol. 2010;21(5-6):548-555.  https://doi.org/10.1097/FBP.0b013e32833d5a59
  75. Liepinsh E, Vilskersts R, Skapare E, et al. Mildronate decreases carnitine availability and up-regulates glucose uptake and related gene expression in the mouse heart. Life Sci. 2008;83(17-18):613-619.  https://doi.org/10.1016/j.lfs.2008.08.008
  76. Sjakste N, Gutcaits A, Kalvinsh I. Mildronate: an antiischemic drug for neurological indications. CNS Drug Rev. 2005;11(2):151-168.  https://doi.org/10.1111/j.1527-3458.2005.tb00267.x
  77. Pupure J, Isajevs S, Skapare E, et al. Neuroprotective properties of mildronate, a mitochondria-targeted small molecule. Neurosci Lett. 2010;470(2):100-105.  https://doi.org/10.1016/j.neulet.2009.12.055
  78. Isajevs S, Isajeva D, Beitnere U, et al. Mildronate as a regulator of protein expression in a rat model of Parkinson’s disease. Medicina (Kaunas). 2011;47(10):552-559. 
  79. Gaidar BV, Parfenov VE, Vainshtein GB. Puti optimizatsii mozgovogo krovoobrashcheniya pri ekstremal’nykh vozdeistviyakh na golovnoi mozg. Fiziologicheskii zhurnal SSSR im. I.M. Sechenova. 1989;11:1568-1575. (In Russ.).
  80. Statsenko ME, Belenkova SV, Sporova OE, Shilina NN. The Use of Mildronate in the combined therapy of chronic heart failure in the post-infarction period in patients with type 2 diabetes. Clinical medicine. 2007;85(7):39-42. (In Russ.).
  81. Suslina ZA, Maksimova MJu, Fedorova TN. Chronic cerebrovascular disease: clinical efficacy and antioxidant effects of mildronat. Vrach. 2007;(4):40-45. (In Russ.).

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