Cryptogenic ischemic stroke and embolic stroke of undetermined source: clinical implications and importance for detection of covert atrial fibrillation in Japan

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  • Toyoda Kazunori
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Okumura Ken
    Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
  • Hashimoto Yoichiro
    Department of Neurology, Kumamoto City Hospital
  • Ikeda Takanori
    Department of Cardiovascular Medicine, Toho University Faculty of Medicine
  • Komatsu Takashi
    Division of Cardio-angiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University
  • Hirano Teruyuki
    Department of Stroke and Cerebrovascular Medicine, Kyorin Universiy Faculty of Medicine
  • Fukuda Haruhisa
    Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University
  • Matsumoto Kazuo
    Higashimatsuyama Medical Association Hospital
  • Yasaka Masahiro
    Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center

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Other Title
  • 潜因性脳梗塞と塞栓源不明脳塞栓症：わが国における臨床的意義と潜在性心房細動検出の重要性

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Cryptogenic ischemic stroke, stroke with no clear definable cause even after extensive workup, does not have fixed diagnostic criteria. Proportion of this type of stroke among overall ischemic stroke varies much, ranging from 16% to 39%. Majority of cryptogenic ischemic stroke is considered as embolism, and the concept of embolic stroke of undetermined source has been recently proposed. In particular, covert atrial fibrillation is drawing attention, and it was identified in 30% of patients in long-term observation using an insertable cardiac monitor. A next-generation insertable cardiac monitor is small and has the capability of remote monitoring. Thus, it has been in clinical use to detect atrial fibrillation in patients with cryptogenic ischemic stroke in the United States, Europe, and Australia. If atrial fibrillation would be identified, anticoagulants can be legally used for prevention of stroke recurrence, and could reduce its recurrence in patients with cryptogenic ischemic stroke. A request has been submitted by the Japan Stroke Society to the Ministry of Health, Labor and Welfare, Japan, indicating the high medical needs of the next-generation insertable cardiac monitor to detect covert atrial fibrillation after cryptogenic ischemic stroke. If the use of the device is approved, patients appropriate for the use should be selected based on detailed examination including head MRI in accordance with the current situation of medical practice in Japan.

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