Abstract WP257: Occurrence and Imaging Patterns of Recurrent Strokes iIn a Cohort of Cryptogenic Stroke Patients on Long Term Cardiac Monitoring

Abstract

Introduction: Cryptogenic strokes account for one third of all strokes. Atrial fibrillation has been described as a leading cause in this population but occurrence of atrial fibrillation and imaging charecteristics amongst recurrent strokes in this population have not been characterized well. Methods: We reviewed electronic medical charts of a cohort of cryptogenic patients from February 2014 to September 2017 who underwent REVEAL LINQ insertable cardiac monitor. All patients met ESUS( Embolic Stroke of Unknown Source) criteria prior to implantation and were enrolled in the atrial fibrillation clinic with structured remote follow-up. All newly diagnosed atrial fibrillation was confirmed by electrophysiologists and recurrent strokes were confirmed by vascular neurologist after reviewing presentation, electronic medical record and brain imaging studies. Results: Atrial fibrillation was detected in 108 out of a total of 429 patients ( 25%) . Time to atrial fibrillation detection was average 79.8 days with a range of 13-430 days . All but one patient were started on anticoagulation. Within the entire cohort 55 patients had recurrent strokes with 7 of them having more than 1 recurrence.. 15 recurrent strokes occurred in patients in whom atrial fibrillation was detected during monitoring and 40 in patients without atrial fibrillation detected . Imaging pattern of recurrent strokes in patients with atrial fibrillation was cortical in 81.8% with 10 patients showing multiple infarcts and subcortical in 18.2% patients with one showing multiple infarcts. Strokes in patients without atrial fibrillation were cortical in location in 60% with 10 being multiple and subcortical in 40% with 3 patient having multiple infarcts.4 patients who did not have atrial fibrillation had more than 1 recurrent stroke and 3 patients who were detected to have atrial fibrillation had more than 1 recurrent stroke Conclusion majority of recurrent strokes in cryptogenic population did not have atrial fibrillation( 72.7%) Incidence of recurrent stroke was similar in patients with atrial fibrillation (13.8%) detected versus (12.4% %)not detected group . Imaging patterns showed more cortical strokes in A. fib patients ( 80%) and more subcortical strokes in patients without A. fib( 40%)