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WSC 2022 | Cryptogenic stroke: evidence for new stroke mechanisms

Ana Catarina Fonseca, MD, PhD, University of Lisbon, Lisbon, Portugal, discusses the latest evidence on the evaluation and treatment of cryptogenic stroke. A specific cause cannot be identified in up to 30% of strokes despite extensive investigation. Some evidence supports the use of prolonged cardiac monitoring as part of cryptogenic stroke evaluation, but the optimal type, timing, and length of this monitoring remains unknown. It is also becoming increasingly recognized that novel mechanisms beyond atrial fibrillation are likely at play in some cases. For example, atrial cardiopathy may be among the mechanisms of unexplained stroke, due to alterations that increase the likelihood of thrombus formation. Complicated carotid artery plaques have also been implicated as a cause of cryptogenic stroke. While stenosis greater than 50% is typically required for a diagnosis of large artery stroke, recent evidence suggests that certain plaque characteristics are key in determining stroke risk beyond the extent of stenosis. These newly proposed mechanisms provide new avenues for investigation in this setting. This interview took place at the World Stroke Congress 2022 in Singapore.

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