By Jana Soeldner Danger
City & Shore Magazine
After a stroke, it’s important to minimize the risk of a second one. Sometimes, however, the cause of a stroke isn’t readily discernible, making it more difficult to treat.
A long-term stroke monitoring program at Boca Raton Regional Hospital, part of Baptist Health South Florida, can identify the cause even long after a patient leaves the hospital, says Dr. Brian Snelling, medical director of the Marilyn & Stanley Barry Center for Cerebrovascular Disease & Stroke at the Marcus Neuroscience Institute at BRRH.
“When someone is diagnosed with a stroke, the first step is figuring out where it came from,” Dr. Snelling says. “It helps to get the right diagnosis so we can administer the correct medication.”
Finding the cause
Most strokes are caused either by plaque buildup in the carotid arteries, or by blood clots resulting from irregular or rapid heart rhythms – atrial fibrillation, or AFib. When the heart doesn’t pump efficiently and the beats are abnormal, blood may become stagnant and prone to clotting. When the heart starts beating normally again, a clot can go to the brain, resulting in a stroke.
The doctor often can determine the cause of a stroke by doing an echocardiogram and ultrasound, but not always. “For most people, we can find the source,” Dr. Snelling says. “But for some [called cryptogenic strokes], we can’t.”
About 30 percent of patients who have an ischemic stroke — one caused by a clot that stops blood supply to an area of the brain – leave the hospital without identifying the cause, says Stephanie Rubenstein, the former stroke coordinator and a current consultant for BRRH. Many don’t have symptoms, so the abnormal heartbeats may go undetected and can significantly increase the risk of another stroke.
“Patients that have suffered cryptogenic stroke often have undiagnosed atrial fibrillation or other cardiac complications months after being discharged from a hospital,” Dr. Snelling says. “Traditional programs typically end weeks or even days after the initial stroke.”
BRRH’s long-term monitoring program uses a system called the Reveal LINQ to track a patient’s heartbeats. A tiny cardiac monitor is implanted under the skin on a patient’s chest through an incision less than a centimeter long, resulting in minimal scarring. The LINQ continuously monitors heart activity to capture abnormal beats, and the monitor conveys the information to a bedside transmitter that relays it to electrophysiologists, specialized cardiac physicians. The procedure is done under local anesthetic in the doctor’s office and takes only a few minutes, Dr. Snelling says.
Abnormal heart rhythms may come and go sporadically and may last only a few seconds. There may be days, weeks or months between episodes, so continual monitoring can be lifesaving. Once abnormal heart rhythms are detected and analyzed, the doctor can adjust medications accordingly. The device lasts for about three years. “The Reveal LINQ system is enabling us to detect heart disturbance on a long-term basis to facilitate proactive treatment when needed,” Dr. Snelling says. “When we have the right diagnosis, we can administer the correct medications.”
After the procedure, the patient can go home and resume normal activities. “We have some very happy patients,” Rubenstein says.
Boca Raton resident Mohammed Elfadel, one of the first patients in the BRRH cryptogenic stroke pathway program, may owe his life to the LINQ. He came to MNI in July 2018 while having a stroke and was treated with mechanical thrombectomy, a process by which a clot is removed from the brain and circulation is restored. “By restoring circulation to the blocked area of the brain, we prevented more damage from occurring,” Rubenstein says. “The quicker the treatment, the less damage is done.” After treatment, doctors implanted the Reveal LINQ cardiac monitor before Elfadel’s discharge. Nearly a year later, the electrophysiologist team detected AFib in his heart rhythms, and doctors immediately switched his medications.
The change has been successful. “I feel good now,” Elfadel says. “I feel normal. I play tennis four or five times a week, and when I don’t play tennis, I go to the gym.”