Why the study?
Cryptogenic stroke is a heterogeneous condition with diverse underlying causes requiring different secondary prevention strategies, making accurate etiological diagnosis essential to reduce recurrence.
What is the diagnostic yield of continuous cardiac monitoring and clinical evaluation for identifying the underlying etiology of cryptogenic stroke and TIA at 12 months?
What is the diagnostic yield of continuous cardiac monitoring and clinical evaluation for identifying the underlying etiology of cryptogenic stroke and TIA at 12 months?
Continuous cardiac monitoring and comprehensive clinical evaluation over 12 months identified a probable cause in 43% of patients with cryptogenic stroke or TIA, most commonly atrial fibrillation.
May support extended monitoring in cryptogenic stroke; leaves open optimal duration and RCT confirmation before practice change.
Background Cryptogenic stroke is a heterogeneous condition, with a wide spectrum of possible underlying causes for which the optimal secondary prevention may differ substantially. Attempting a correct etiological diagnosis to reduce the stroke recurrence should be the fundamental goal of modern stroke management. Methods Prospective observational international multicenter study of cryptogenic stroke and cryptogenic transient ischemic attack (TIA) patients clinically monitored for 12 months to assign the underlying etiology. For atrial fibrillation (AF) detection continuous cardiac rhythm monitoring with insertable cardiac monitor (Reveal LINQ, Medtronic) was performed. The 12-month follow-up data for 250 of 259 initially included NOR-FIB patients were available for analysis. Results After 12 months follow-up probable stroke causes were revealed in 43% patients, while 57% still remained cryptogenic. AF and atrial flutter was most prevalent (29%). In 14% patients other possible causes were revealed (small vessel disease, large-artery atherosclerosis, hypercoagulable states, other cardioembolism). Patients remaining cryptogenic were younger ( p < 0.001), had lower CHA 2 DS 2 -VASc score ( p < 0.001) on admission, and lower NIHSS score ( p = 0.031) and mRS ( p = 0.016) at discharge. Smoking was more prevalent in patients that were still cryptogenic ( p = 0.014), while dyslipidaemia was less prevalent ( p = 0.044). Stroke recurrence rate was higher in the cryptogenic group compared to the group where the etiology was revealed, 7.7% vs. 2.8%, ( p = 0.091). Conclusion Cryptogenic stroke often indicates the inability to identify the cause in the acute phase and should be considered as a working diagnosis until efforts of diagnostic work up succeed in identifying a specific underlying etiology. Timeframe of 6-12-month follow-up may be considered as optimal. Trial registration ClinicalTrials.gov Identifier NCT02937077, EudraCT 2018-002298-23.
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Ratajczak‐Tretel et al. (2023) studied this question.
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