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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. |
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