비판막성 심방세동환자에서 뇌경색의 유형과 자기공명 뇌혈관촬영 소견

Abstract

Background: In clinical practice, some patients with non- valvular atrial fibrillation (NVAF) presented with acute stroke might be considered as a cardioembolic infarction, regardless of the presence of large artery atherosclerosis or small vessel disease. The aims of this study were to elucidate the clinical and pathophysiologic implications of cerebral infarction in the patient with NVAF on the basis of clinical and neuroimaing data. Methods: We reviewed medical records and brain images of consecutive 71 patients with acute ischemic stroke having N VAF registered to Hallym Stroke Registry between Jan. 1999 and Feb. 2002. The risk factor, the pattern of infarcts and concomitant arterial stenosis were analyzed. Results: Smoking (p=0.04) and hyperlipidemia (p=0.02) were more common in control group, who have acute ischemic stroke with normal sinus rhythm and without potential cardioembolic source, than in NVAF group. MCA territory infarct involving cortex was most common. Nine (12.7%) of 71 patients with NVAF were presented with small deep subcortical infarction (SDSCI). Twentyone (35.5%) of severe stenosis (>50%) were noted, and 9 (15.3%) of them were located at the corresponding artery to acute infarct. Conclusions: At present, as any clinical criteria of stroke subtype, is not capable of revealing actual pathophysiologic mechanism, strokes with NVAF may be partly misclassified as cardioembolic infarct even if they caused by concomitant arterial stenosis or small vessel disease. This study suggests that the exact cause of stroke in patient with NVAF be carefully considered before initiating antithrombotic therapy for secondary prevention.