Pathogenesis of anterior circulation stroke in patients with nonvalvular atrial fibrillation : the Lausanne stroke registry

• Published in: Neurology Vol. 40; no. 7; pp. 1046 - 1050
• Main Authors: BOGOUSSLAVSKY, J, VAN MELLE, G, REGLI, F, KAPPENBERGER, L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-07-1990
• Subjects: Adult; Aged; Aged, 80 and over; Arterial Occlusive Diseases - complications; Atrial Fibrillation - complications; Biological and medical sciences; Brain Ischemia - etiology; Cerebral Infarction - etiology; Cerebrovascular Disorders - etiology; Coronary Disease - complications; Electrocardiography; Female; Heart Valve Diseases - complications; Humans; Male; Medical sciences; Middle Aged; Neurology; Registries; Switzerland; Vascular diseases and vascular malformations of the nervous system; Switzerland; Heart; Human; Cerebral infarction; Stroke; Nervous system diseases; Arrhythmia; Pathogenesis; Acute; Atrial fibrillation; Cardiovascular disease; Excitability disorder; Follow up study; Carotid; Cerebrovascular disease
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/wnl.40.7.1046

We studied coexisting potential arterial and cardiac causes of stroke in 159 patients with nonvalvular atrial fibrillation (AF), who were admitted to a population-based primary care center for an anterior circulation infarct. Systematic investigations included brain CT, carotid Doppler ultrasounds with frequency analysis and echotomography, and mono- and bidimensional echocardiography. Lacunar infarction due to small-artery disease was at least as likely as an AF-related stroke in 13% of the patients who had hypertension and a small deep infarct. In 67% of the patients, internal carotid artery disease ipsilateral to infarct was present, but it was severe (greater than or equal to 50% stenosis or occlusion) in only 11%. There was a potential cardiac source of embolism other than AF in 14%. Overall, although only 18% of the patients had AF as the only potential cause of stroke, embolism from the heart remained the most likely etiology of infarct in 76%. Our findings emphasize the role of AF-related hemodynamic disturbances, which were often associated with embolic phenomena, and a rather low early risk of recurring embolism (4%) within the 1st month after stroke.