Research Topic

Current Challenges in Cardioembolic Stroke

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Cardioembolism is one of the most frequent causes of ischemic stroke, accounting for 20% of all ischemic strokes. Moreover, cardioembolic stroke entails higher severity and poorer outcome compared to other aetiologies. Atrial fibrillation is the most frequent underlying disease, although several other cardiac ...

Cardioembolism is one of the most frequent causes of ischemic stroke, accounting for 20% of all ischemic strokes. Moreover, cardioembolic stroke entails higher severity and poorer outcome compared to other aetiologies. Atrial fibrillation is the most frequent underlying disease, although several other cardiac disorders such as ventricular akinesia, valvular heart disease, acute myocardial infarction or complicated interventional cardiac procedures can also be involved in the development of cardioembolic stroke. In recent years, much attention has been paid to the search of hidden cardioembolic sources for ischemic stroke, and the “embolic stroke of unknown source (ESUS)” concept was raised to improve the detection of occult embolic diseases, mainly paroxysmal atrial fibrillation.

Despite the recent development of long-term cardiac monitoring devices and safer oral anticoagulant drugs, cardioembolic stroke remains an important challenge for stroke physicians and acute management can be difficult. Intravenous thrombolysis could be contraindicated and mechanical thrombectomy could be the only recanalization therapy in cases harboring a large vessel occlusion. To continue or discontinue the oral anticoagulants during the first days after ischemic stroke is also remains an open question.

On the other hand, the failure of direct oral anticoagulants in recent clinical trials with patients diagnosed with ESUS has raised concerns regarding the appropriateness of a low-intensity diagnostic workup and points to the return of the diagnostic concept of cryptogenic stroke. This highlights the need to increase the search of potential hidden etiologies through advanced diagnostic procedures.

Finally, direct oral anticoagulants have revolutionized stroke prevention in patients suffering from atrial fibrillation, however more knowledge is needed regarding the long-term outcomes in patients treated with these drugs. Furthermore, prospective registries in secondary stroke prevention are also required.

Therefore, we welcome manuscripts focused on the challenge of diagnosis and management of cardioembolic strokes including, albeit not restricted to: atrial fibrillation, atrial cardiopathy, aortic sources of embolism, blood and imaging biomarkers (cardiac TC, cardiac MRI, echocardiography, etc.), screening strategies to detect paroxysmal atrial fibrillation, acute management of cardioembolic strokes (including reperfusion therapies), antithrombotic strategies in long-term cardioembolic stroke prevention, the management of the combination of cardioembolic and arterial sources of embolism, and the appropriateness of the ESUS concept.

As there is an ongoing Research Topic that deals with Stroke and PFO, we are not calling papers specifically on PFO, although we will welcome those related to the challenge of atrial fibrillation development after PFO closure.


Keywords: Cardioembolic Stroke, Atrial Fibrillation, Embolic Stroke of Unknown Source (ESUS), Anticoagulants, Cardiac Monitoring


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