Related Experiment Video
Updated: Jul 2, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Presence of Residual Cardiac Thrombus Predicts Poor Outcome in Cardioembolic Stroke After Reperfusion Therapy
Tingxia Zhang1, Huan Zhou1, Jiansheng Yang1
1Department of Neurology The 2nd Affiliated Hospital of Zhejiang University, School of Medicine Hangzhou China.
Insights
Residual cardiac thrombus is found in about one-third of stroke patients post-reperfusion therapy. This finding is linked to worse clinical outcomes, highlighting its importance in cardioembolic stroke management.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Acute cardiogenic cerebral embolism can leave residual cardiac thrombus post-reperfusion.
- Investigating residual thrombus and its clinical impact is crucial.
Purpose of the Study:
- To determine the occurrence of residual cardiac thrombus in cardioembolic stroke patients after reperfusion.
- To analyze the association between residual cardiac thrombus and clinical outcomes.
Main Methods:
- Prospective data collection of cardioembolic stroke patients.
- Two-phase cardiac computed tomography (CT) within 7 days of reperfusion.
- Defined residual cardiac thrombus as a filling defect on both early- and late-phase CT images.
Main Results:
- 94 out of 303 patients (31.0%) had residual cardiac thrombus.
- Residual cardiac thrombus was associated with poor clinical outcome (OR, 1.951; P=0.041).
- Circulatory stasis and composite endpoint events were not correlated with residual cardiac thrombus.
Conclusions:
- Residual cardiac thrombus is present in approximately one-third of patients post-reperfusion therapy for cardioembolic stroke.
- The presence of residual cardiac thrombus is an indicator of poor clinical outcome.
Background:
In patients with acute cardiogenic cerebral embolism, a residual thrombus may still be present in the cardiac cavity even after reperfusion therapy. We aimed to investigate the occurrence of a residual cardiac thrombus in cardioembolic stroke after reperfusion therapy and analyze its impact on clinical outcome.
Methods And Results:
We enrolled patients with cardioembolic stroke from our prospectively collected database who underwent 2-phase cardiac computed tomography within 7 days after reperfusion therapy. Residual cardiac thrombus was defined as a filling defect on both early- and late-phase images, whereas circulatory stasis was defined as a filling defect only on the early-phase images in the left atrial appendage. The primary outcome was a poor clinical outcome (modified Rankin Scale score, 3-6) at 90 days. The secondary outcome was a composite end point event (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke) at 90 days. A total of 303 patients were included, of whom 94 (31.0%) had a residual cardiac thrombus. Binary logistic regression analysis showed that the presence of a residual cardiac thrombus was associated with a poor clinical outcome (odds ratio, 1.951 [95% CI, 1.027-3.707]; P=0.041) but not circulatory stasis in the left atrial appendage (odds ratio, 1.096 [95% CI, 0.542-2.217]; P=0.798). Furthermore, there was no correlation between a residual cardiac thrombus and the composite end point event (30.0% versus 31.1%; P=1.000).
Conclusions:
Residual cardiac thrombus occurs in approximately one-third of patients with cardioembolic stroke after reperfusion therapy and is often indicative of a poor clinical outcome.
