What is the role of cardioembolism in the etiology of posterior cerebral artery (PCA) stroke?

Updated: Jul 30, 2018
  • Author: Erek K Helseth, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Cardioembolism, which may arise from a number of different mechanisms, is the most common cause of PCA stroke. The most common cause of cardioembolism is atrial fibrillation, in which emboli form due to vascular stasis, frequently within the atrial appendage. Atrial fibrillation often represents a high-risk etiology for PCA stroke recurrence, particularly if the patient has other identified risk factors, including congestive heart failure, hypertension, age older than 75 years, diabetes mellitus, and prior stroke or transient ischemic attack. These risk factors are the basis of the CHADS2 score, which estimates the risk of recurrent stroke and suggests the benefit of oral anticoagulation based on score. [4]

Other sources of cardiogenic embolism include a mural thrombus on a hypokinetic wall segment (eg, postmyocardial infarction, dilated cardiomyopathy, ventricular aneurysm), endocarditis (bacterial, marantic, Libman-Sacks), prosthetic heart valve thrombosis, rheumatic heart disease, and paradoxical embolism via a patent foramen ovale or atrial septal defect.

Embolism may also arise from aortic arch atheroma. This entity has been elucidated by transesophageal echocardiography, which is more effective than transthoracic echocardiography in examining the aortic arch. Thickness of plaque greater than 4 mm or the presence of a mobile thrombus is strongly associated with stroke.


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