REMOTE MONITORING IN CRYPTOGENIC STROKE

Abstract

Abstract Introduction In the neurological field, one of the pathologies that receives the most attention due to its etiopathogenetic complexity is cryptogenic stroke. In the literature, a significant percentage of cryptogenic stroke is associated with Paroxysmal Atrial Fibrillation (FAP). With this study we wanted to compare our data with those of the literature and evaluate the incidence of remote control in promoting patient adherence to anticoagulant therapy, also analyzing the incidence of possible stroke recurrences in the monitored patients. Methodology All patients admitted to the Stroke Unit with cryptogenic stroke were evaluated with the ESUS SCORE. Patients who tested positive following the administration of the score underwent Loop Recorder (ILR) implantation for prolonged cardiac monitoring. Patients who showed episodes of FAP during monitoring were subsequently referred to the Stroke Unit to start anticoagulant therapy. A close telephone follow-up was subsequently carried out (every 15 days) to evaluate adherence to therapy and any stroke recurrences. Results 43 patients with cryptogenic stroke coming from the Stroke Unit and implanted by our center with Loop Recorder were evaluated. Among these 43 patients, 16 (37%) presented at least one episode of FAP, while 27 (63%) have not yet had any FAP event since the date of device implantation. In 60% of patients with FAP the duration of the event is greater than 5 hours. The time period between the stroke and the first FAP event in 6 out of 16 patients is approximately 1 month. Two patients presented the first episode within 7 days, while 8 patients within 10 months. In the telephone follow-up performed, 100% adherence to anticoagulant therapy was recorded, resulting in a recurrence of stroke in 0% of patients. Conclusions From the results obtained it was possible to conclude that the use of remote monitoring associated with close telephone follow-up allows the diagnosis of FAP and guarantees better patient adherence to anticoagulant therapy, significantly reducing stroke recurrences.