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Updated: Jun 22, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Cardiac workup of ischemic stroke: can we improve our diagnostic yield?
Jane G Morris1, E Jesus Duffis, Marc Fisher
1Department of Neurology, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA 01655, USA. jane.morris@umassmemorial.org
Insights
Identifying cardiac sources of stroke is crucial for preventing future events. This study proposes an algorithmic approach to cardiac evaluation in ischemic stroke patients, optimizing diagnostic yield and cost-effectiveness.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- Identifying cardiac sources of stroke is critical for secondary stroke prevention.
- Optimal cardiac workup strategies for ischemic stroke patients remain undefined.
Observation:
- Literature review on cardiac rhythm monitoring and structural imaging utility in stroke etiology.
- Current data lacks a definitive, optimal, and cost-effective approach.
Findings:
- Appropriate patient selection may enhance the diagnostic and therapeutic yield of cardiac monitoring and echocardiography.
- An algorithmic approach is proposed based on available data.
Implications:
- The proposed algorithm aims to improve the evaluation of acute ischemic cerebrovascular events.
- This approach considers therapeutic and diagnostic yield alongside cost-efficiency for stroke management.
Background And Purpose:
Discovering potential cardiac sources of stroke is an important part of the urgent evaluation of the ischemic stroke patient as it often impacts treatment decisions that are essential for determining secondary stroke prevention strategies, yet the optimal approach to the cardiac workup of an ischemic stroke patient is not known.
Methods:
A review of the literature concerning the utility of cardiac rhythm monitoring (ECG, telemetry, Holter monitors, and event recorders) and structural imaging (transthoracic and transesophageal echocardiography) was performed.
Results:
Data supporting a definitive, optimal, and cost-effective approach are lacking, though some data suggest that appropriate patient selection can improve the diagnostic and therapeutic yield of rhythm monitoring and echocardiography in the evaluation of stroke etiology.
Conclusions:
Based on available data, an algorithmic approach for the evaluation of patients with acute ischemic cerebrovascular events that takes into account therapeutic and diagnostic yield as well as cost-efficiency is proposed.
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