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Stroke is a major cause of morbidity, mortality, and disability. The American Heart Association/American Stroke Association recently published updated guidelines on secondary stroke prevention. In these rounds, 2 vascular neurologists use the case of Mr. S, a 75-year-old man with a history of 2 strokes, to discuss and debate questions in the guideline concerning intensity of atrial fibrillation monitoring in embolic stroke of undetermined source, diagnosis and management of moderate symptomatic carotid stenosis, and therapeutic strategies for recurrent embolic stroke of undetermined source in the setting of guideline-concordant therapy.
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http://dx.doi.org/10.7326/M23-3136 | DOI Listing |
PLoS Comput Biol
September 2025
Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado, United States of America.
Deciphering the source of an embolism is a common challenge encountered in stroke treatment. Carotid stenosis is a key source of embolic strokes. Carotid interventions can be indicated when a patient has greater than 50% stenosis in the carotid ipsilateral to the cerebral infarction, which is designated as the symptomatic carotid.
View Article and Find Full Text PDFJ Neurointerv Surg
September 2025
Neurosurgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Objective: Non-acute subdural hematomas (NASDHs) often recur or persist, particularly among older patients with comorbidities. Middle meningeal artery embolization (MMAe) has emerged as a promising primary treatment alternative. Dual-lumen balloon microcatheters significantly reduce the risk of reflux, which is a limitation of single-lumen microcatheters.
View Article and Find Full Text PDFCatheter Cardiovasc Interv
September 2025
Oklahoma Heart Hospital, Oklahoma City, Oklahoma, USA.
Transcatheter aortic valve replacement (TAVR) is widely used to treat severe aortic stenosis; however, periprocedural stroke remains a significant concern. This systematic review and meta-analysis evaluate whether the use of cerebral embolic protection devices (CEPDs) during TAVR reduces the risk of stroke and other complications. To conduct a network meta-analysis of relevant trials to assess the efficacy of CEPDs currently used in TAVR.
View Article and Find Full Text PDFFront Oncol
August 2025
Stroke Unit, Emergency Department, Umberto I Hospital, Sapienza University of Rome, Rome, Italy.
The association between ischemic stroke (IS) and malignancy is well established. Cancer-related strokes are predominantly embolic and classified as embolic strokes of undetermined source (ESUS). While malignancy-associated coagulopathy represents the primary pathogenic mechanism, neoplastic embolization of circulating tumor cells is another potential etiology, particularly in cases of cardiac and pulmonary malignancies.
View Article and Find Full Text PDFCureus
July 2025
Department of Cardiology, Penn Cardiology, Vineland, USA.
Background Lambl's excrescences (LE) and cardiac papillary fibroelastomas (CPF) are valvular structures that have been associated with cryptogenic strokes, potentially acting as embolic sources or sites of thrombus formation. However, the management of LE and CPF - whether discovered incidentally or in the setting of cerebrovascular events (cardiovascular accident (CVA)/transient ischemic attack (TIA)) - remains poorly defined, with no randomized trials to guide treatment. Methods We conducted a retrospective case series at a single center from July 2018 to June 2024, identifying 10 patients with LE or CPF.
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