Key result
ICM and CTA re-assessment identifies covert stroke sources, reclassifying etiology in ~48% of patients.
Why the study?
Different mechanisms may underlie cryptogenic stroke, motivating an evaluation of subclinical AF, nonstenotic carotid plaques, and aortic arch atherosclerosis to reclassify stroke etiology and compare clinical features.
Does long-term implantable cardiac monitoring and CTA re-assessment improve etiologic reclassification in patients with cryptogenic stroke?
Observational (n=63)
No
Does long-term implantable cardiac monitoring and CTA re-assessment improve etiologic reclassification in patients with cryptogenic stroke?
Long-term cardiac monitoring and focused CTA re-assessment can identify a potential covert stroke source in nearly half of patients initially diagnosed with cryptogenic stroke.
Answers are grounded in this paper and cite their sources.
Should not yet change cryptogenic stroke evaluation; leaves open whether reclassification improves outcomes.
INTRODUCTION: Different mechanisms may underlie cryptogenic stroke, including subclinical atrial fibrillation (AF), nonstenotic carotid plaques (NCP), and aortic arch atherosclerosis (AAA). In a cohort of cryptogenic stroke patients, we aimed to: (1) evaluate the prevalence of subclinical AF, NCP, and AAA, and reclassify the etiology accordingly; (2) compare the clinical features of patients with reclassified etiology with those with confirmed cryptogenic stroke. METHODS: Data of patients hospitalized for cryptogenic stroke between January 2018 and February 2021 were retrospectively analyzed. Patients were included if they received implantable cardiac monitoring (ICM) to detect subclinical AF. Baseline computed tomography angiography (CTA) was re-evaluated to assess NCP and AAA. Since aortic plaques with ulceration/intraluminal thrombus were considered pathogenetic during the initial workup, only patients with milder AAA were included. Stroke etiology was reclassified as "cardioembolic", "atherosclerotic", or "mixed" based on the detection of AF and NCP/AAA. Patients with "true cryptogenic" stroke (no AF, ipsilateral NCP, or AAA detected) were compared with those with reclassified etiology. RESULTS: Among 63 patients included, 21 (33%) were diagnosed with AF (median follow-up time of 15 months), 12 (19%) had ipsilateral NCP, and 6 (10%) had AAA. Stroke etiology was reclassified in 30 patients (48%): cardioembolic in 14 (22%), atherosclerotic in 9 (14%), and mixed in 7 (11%). Patients with true cryptogenic stroke were younger compared to those with reclassified etiology (p = 0.001). DISCUSSION: One or more potential covert stroke sources can be recognized in half of the patients with a cryptogenic stroke through long-term cardiac monitoring and focused CTA re-assessment.
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Mele et al. (2022) conducted an observational in Cryptogenic stroke (n=63). Implantable cardiac monitoring (ICM) and CTA re-assessment was evaluated on Etiologic reclassification of stroke. Implantable cardiac monitoring and computed tomography angiography re-assessment identified a potential covert stroke source, leading to etiologic reclassification in 48% of patients.
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