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Cryptogenic stroke: Contemporary trends, treatments, and outcomes in the United States

Shyam Prabhakaran1, Steven R Messé1, Dawn Kleindorfer1

  • 1University of Chicago (SP), Pritzker School of Medicine; University of Pennsylvania (SRM); University of Cincinnati (DK); Hotchkiss Brain Institute (EES), University of Calgary, Calgary, Alberta, Canada; Ahmanson Cardiomyopathy Center (GCF), UCLA, Los Angeles, CA; Duke Clinical Research Institute (HX, XZ, BL), Durham, NC; Knight Cardiovascular Institute (JC), Oregon Health and Sciences University; and Department of Neurology (LHS), Massachusetts General Hospital.

Neurology. Clinical Practice
|December 10, 2020
PubMed

Insights

Cryptogenic stroke (CS) accounts for 20% of ischemic strokes. Patients with CS received more IV thrombolysis and had better discharge outcomes than most other stroke subtypes, though mortality was higher than small vessel occlusion.

Area of Science:

  • Neurology
  • Cardiovascular Research
  • Public Health

Background:

  • Nationwide data on cryptogenic stroke (CS) patients are limited.
  • The Get With The Guidelines (GWTG)-Stroke registry provides a large dataset for analysis.
  • Understanding CS patient characteristics and outcomes is crucial for improving stroke care.

Purpose of the Study:

  • To evaluate patient and hospital characteristics of CS.
  • To compare in-hospital treatments and discharge outcomes for CS versus other stroke subtypes.
  • To identify trends in CS management and outcomes within a large registry.

Main Methods:

  • Analysis of ischemic stroke (IS) patients from January 2016 to September 2017 in the GWTG-Stroke registry.
  • Inclusion of patients with documented National Institutes of Health Stroke Scale (NIHSS) and stroke etiology.
  • Multivariable logistic regression used to compare treatments and outcomes across stroke subtypes (CS, cardioembolic [CE], large artery atherosclerosis [LAA], small vessel occlusion [SVO], other [OTH]).

Main Results:

  • Cryptogenic stroke (CS) comprised 20% (63,301/316,623) of ischemic strokes.
  • CS patients received IV thrombolysis more frequently than other subtypes.
  • CS patients had lower mortality than CE, LAA, and OTH, but higher than SVO, and were more likely to be discharged home independently.

Conclusions:

  • Cryptogenic stroke (CS) represents a significant proportion of ischemic strokes with distinct treatment and outcome profiles.
  • Patients with CS demonstrate a unique pattern of care and recovery compared to other stroke etiologies.
  • Enhanced documentation and further research into CS are essential for optimizing patient care and outcomes.
Abstract

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