Treatment Outcome Using Insertable Cardiac Monitoring in Patients with Cryptogenic Stroke after Thrombectomy

Abstract

Objective: Insertable cardiac monitoring (ICM) systems are useful for diagnosing paroxysmal atrial fibrillation (PAF) in cryptogenic stroke (CS). We assessed the initial treatment outcome using insertable cardiac monitors in CS treated by endovascular reperfusion therapy. Methods: Of 102 consecutive acute ischemic stroke patients with large vessel occlusion (LVO) treated by endovascular therapy, we included 10 with CS who underwent insertable cardiac monitor placement between December 2016 and June 2018 at our hospital. Atrial fibrillation (AF) was determined by performing screening tests such as 12-lead electrocardiography (ECG), Holter ECG, and continued electrocardiographic monitoring for 3 days. Transesophageal echocardiogram (TEE) was essential to diagnose CS. We analyzed the parameters of AF and the time at which AF was first detected within 1 year. Results: There were eight (80%) male patients, and the median age was 68 (interquartile range [IQR]: 59–76) years. The parameters of AF were not outliers. The detection rate of AF at 12 months was 60%. The median time from onset of stroke to device insertion was 17 (range: 10–22) days, and the median time from device insertion to detection of the first AF episode was 52 (range: 12–344) days. Conclusion: The detection rate of AF in acute ischemic stroke patients with LVO treated by endovascular therapy was higher than that in previous reports.