Cryptogenic strokes can make patients feel adrift without answers
LINQTM family of Insertable Cardiac Monitors (ICMs) will show you the way forward. Our NICE-recommended ICM solution can bring clarity and peace of mind.1
1.3 Million
stroke survivors in the UK2
25%
of ischemic stroke survivors remain cryptogenic, despite a comprehensive diagnostic workup3
Up to 30%
of patients with cryptogenic stroke may have previously undetected paroxysmal AF.4
Cryptogenic Strokes can make patients feel adrift without answers
NEW: The latest UK & Ireland National Clinical Guidelines for Stroke have incorporated a new recommendation, stating that implantable loop recorders should be considered for patients suitable for anticoagulation who have experienced an ischaemic stroke or TIA, and have undergone extensive neurovascular investigation without identifying any other cause of stroke (such as cryptogenic stroke), especially when a cardioembolic cause is suspected.8
The path away from secondary strokes can be plain sailing
The new ESO guidelines recommend, to maximize AF detection, clinicians should monitor cryptogenic stroke/TIA patients with implantable cardiac monitors, starting as soon as possible.5
David is 55 years old and a senior manager at an IT company. David had a stroke last year, but the cause couldn’t be identified despite in-hospital investigations, including an electrocardiogram (ECG), 24-hour ambulatory monitor and echocardiogram.
A diagnosis of cryptogenic stroke was made and he was discharged on antiplatelet therapy, blood pressure medication and statins.
Two months ago, he had a devastating second stroke… Scroll down and read the two downloadable documents to learn more about David’s journey and learn how leading clinicians approach cryptogenic stroke cases.
Guides to navigating Cryptogenic strokes
An expert-written guide to setting up an ICM service
Improving detection of atrial fibrillation after cryptogenic stroke with Implantable Cardiac Monitors (ICMs)
An expert-written case for change
Improving outcomes after cryptogenic stroke:
Why we need to address the patient pathway
- Dr Indira Natarajan, Clinical Director Neurosciences and Clinical Director for Stroke West Midlands Integrated Stroke Delivery Network
- Rachel Powell, Physician Associate specialised in Stroke Medicine
- Vince Walker, Senior Chief Cardiac Physiologist, Head of Electrophysiology
Cardiology-neurology referral pathway
The importance of multidisciplinary approach
Case study:
Salford Royal NHS Foundation Trust
Salford Royal NHS Foundation Trust added the use of an implantable cardiac monitor in people following cryptogenic stroke to their post-stroke aftercare pathways to help increase the detection of Atrial fibrillation (AF). This is in line with the NICE diagnostics guidance; Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke DG41.
Case study:
Cambridge University Hospitals NHS Foundation Trust
Cambridge University Hospitals NHS Foundation Trust have increased capacity to insert implantable cardiac monitors to detect atrial fibrillation after cryptogenic ischaemic stroke by using the joint stroke / cardiology multidisciplinary team, which is working to identify suitable patients.
Finding a diagnosis for cryptogenic stroke patients is challenging and requires a personalized approach.
Learning Objectives:
- Understand the latest guidance in patient risk stratification and monitoring strategies for Atrial Fibrillation in cryptogenic stroke patients.
- Explore clinical and economic evidence supporting patient outcomes and cost-effectiveness of insertable loop recorders in cryptogenic stroke patients.
If you plan to apply for a commissioned service and need support with the business case and dynamic healthcare economic model, please get in touch!
Jeanette was 57 years old when she suffered a stroke.
Listen to Jeanette’s story to hear how she felt about having Reveal LINQ™ inserted and how it improved her life.
References
1
Reveal LINQ is recommended as an option to help to detect atrial fibrillation after cryptogenic stroke, including transient ischaemic attacks (TIA), only if non-invasive electrocardiogram (ECG) monitoring has been done and a cardiac arrhythmic cause of stroke is still suspected. NICE Diagnostics Guidance 41: Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke. September 2020 © NICE 2020. View full guidance
3
Saver, JL. Cryptogenic Stroke. N Engl J Med 2016;374:2065-74.
4
Sanna T, et al. N Engl J Med. 2014;370:2478-2486
5
Rubiera M, Aires A, Antonenko K, et al. European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin. European Stroke Journal. May 2022. doi:10.1177/23969873221099478
6
Tsivgoulis G, et al. Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia. Stroke. Published online June 20, 2019. doi: https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.025169
7
ICM Published Accuracy Comparison Guide. 2021.
8
The National Clinical Guideline for Stroke for the UK and Ireland: 2023 edition. View guidelines: https://www.strokeguideline.org/chapter/long-term-management-and-secondary-prevention/#462
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