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Review
. 2021 Oct 16;23(12):174.
doi: 10.1007/s11886-021-01604-1.

Stroke Prevention After Cryptogenic Stroke

Chinwe Ibeh  1 , Mitchell S V Elkind  2   3
Affiliations
Review

Stroke Prevention After Cryptogenic Stroke

Chinwe Ibeh et al. Curr Cardiol Rep. .

Abstract

Purpose of review: Cryptogenic stroke represents a heterogenous but clinically important collection of stroke etiologies for which our understanding continues to grow. Here, we review our current knowledge and most recent recommendations on secondary prevention for common causes of cryptogenic stroke including paroxysmal atrial fibrillation, atrial cardiopathy, patent foramen ovale, and substenotic atherosclerotic disease as well as the under-recognized mechanisms of occult malignancy, heart failure, and, most recently, infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Recent findings: The results from recent observational studies and randomized clinical trials have provided greater insight into the causal relationship and attributable risk of these suspected etiologies and have identified potential strategies to reduce the rates of recurrence. However, further clinical trials are needed to confirm the benefits of specific stroke prevention strategies, including the patient populations most likely to benefit from anticoagulation. There is ongoing research aimed at both reducing the proportion of ischemic strokes classified as cryptogenic and resolving much of the clinical equipoise that still exists. The results of these studies have the potential to provide us with a better understanding of these occult mechanisms and allow for more targeted interventions.

Keywords: Atrial cardiopathy; Atrial fibrillation; Cryptogenic stroke; Heart failure; Malignancy, COVID-19.

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Conflict of interest statement

Dr. Elkind declares receipt of research funding in kind from the BMS-Pfizer Alliance for Eliquis® and research funding, but no personal compensation, from Roche, both for a National Institutes of Health-funded trial of stroke prevention; and royalties from UpToDate for chapters on cryptogenic stroke and COVID-19. Dr. Ibeh declares no conflict of interest.

Figures

Fig. 1
Fig. 1
CT head demonstrating left parieto-occipital hypodensity with localized sulcal effacement and edema (A) along with CTA showing partial occlusion of the distal left PCA (B, red arrow), consistent with embolic infarction and partial recanalization, in a 56-year-old man with poorly controlled diabetes and hypertension who presented with right hemianopsia and alexia without agraphia. He had a flu-like illness and was diagnosed with COVID-19 approximately three months before, followed by severe cardiomyopathy with left ventricular ejection fraction of 15%, unexplained by coronary artery disease. There was severe left atrial enlargement but no atrial fibrillation. He was thought to have a viral cardiomyopathy due to SARS-CoV-2, complicated by heart failure and cardioembolic stroke
See this image and copyright information in PMC

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