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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Cryptogenic stroke as a working diagnosis: the need for an early and comprehensive diagnostic work-up

Maurizio Acampa1,2, Pietro Enea Lazzerini3, Simona Lattanzi4

  • 1Stroke Unit, Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General-Hospital, Siena, Italy. M.Acampa@ao-siena.toscana.it.

BMC Neurology
|April 14, 2023
PubMed

Insights

The Nordic Atrial Fibrillation and Stroke study found causes in 43% of cryptogenic stroke patients with implantable cardiac monitors (ICM). However, many had non-cardioembolic reasons, suggesting earlier diagnostics are needed.

Area of Science:

  • Cardiology
  • Neurology
  • Stroke Research

Background:

  • The Nordic Atrial Fibrillation and Stroke (NOR-FIB) study investigated etiological causes of ischemic stroke in patients with cryptogenic stroke.
  • Implantable cardiac monitors (ICM) are used to detect atrial fibrillation, a common cause of cardioembolic stroke.

Discussion:

  • The study identified causes in 43% of patients monitored with ICM.
  • A significant proportion (one-third) of identified causes were non-cardioembolic.
  • This challenges the assumption that ICM alone is sufficient for etiological diagnosis in all cryptogenic stroke cases.

Key Insights:

  • Implantable cardiac monitors (ICM) detect underlying causes in a substantial portion of cryptogenic stroke patients.
  • Non-cardioembolic etiologies represent a significant finding in patients undergoing ICM monitoring.
  • Early and comprehensive diagnostic work-up is crucial before considering ICM insertion.

Outlook:

  • Further research should focus on refining diagnostic algorithms for cryptogenic stroke.
  • Optimizing the timing and selection of diagnostic tools, including ICM, is essential.
  • Improving etiological diagnosis can lead to more targeted stroke prevention strategies.

Keywords:
Atrial cardiopathyAtrial fibrillationCryptogenic strokeImplantable cardiac monitorNoncardioembolic strokeNonstenosing atherosclerosis

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