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

Neurology. 1990 Jul;40(7):1046-50. doi: 10.1212/wnl.40.7.1046.

Abstract

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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arterial Occlusive Diseases / complications
  • Atrial Fibrillation / complications*
  • Brain Ischemia / etiology
  • Cerebral Infarction / etiology
  • Cerebrovascular Disorders / etiology*
  • Coronary Disease / complications
  • Electrocardiography
  • Female
  • Heart Valve Diseases / complications
  • Humans
  • Male
  • Middle Aged
  • Registries
  • Switzerland