BNackground and Aims
Determining the etiology of acute ischemic stroke due to large vessel occlusion (AIS-LVO) is often difficult. In our study, we had three cerebrovascular experts assess the etiology of the stroke.
Methodology
An analysis of patients from the TROMB retrospective study was performed. The results of the examinations performed by three independent experts were independently assessed and the probable etiology of the stroke was determined. The experts' evaluations were compared with each other, and in case of a difference of opinion, the patient was classified as a disagreement.
Results
90 consecutive patients were included in the TROMB study between 2020/2021. Experts1 (E1) and E2 showed agreement of 86.7%, E1-E3 84.4%, E2-E3 80%, and finally all three showed mutual agreement of 76.7%. Cardioembolization etiology was determined in the range between 60-64.4%, atherosclerotic etiology 8.9-14.4%, cryptogenic 6.7-13.3% and another determined 1.1-3.3%. Furthermore, the indication of anticoagulant therapy in the secondary prevention of AIS was assessed from the data (E1-E2). The group with indicated anticoagulation therapy (cardioembolic, cryptogenic, disagreement - at least one of the evaluators considered cardioembolism, others determined with indication of anticoagulation therapy) reached 82.2%. Without inclusion of cryptogenic etiology 73.3%.
Conclusion
A significant majority of AIS-LVO patients appear to be candidates for anticoagulation therapy in the secondary prevention of AIS. The data indicate an indication for anticoagulation treatment in all patients in whom significant atherosclerotic involvement is not already found at stroke onset, at least until the completion of a thorough examination of the etiology of AIS.