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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Left Atrial Appendage Opacification on Cardiac Computed Tomography in Acute Ischemic Stroke: The Clinical

Shan Sui Nio1, Leon A Rinkel1, Olivia N Cramer1

  • 1Department of Neurology Amsterdam UMC, Location University of Amsterdam Amsterdam The Netherlands.

Journal of the American Heart Association
|August 27, 2024
PubMed

Insights

Left atrial appendage (LAA) slow-flow is linked to stroke risk. While not impacting overall outcomes, slow-flow was associated with recurrent strokes in cryptogenic stroke patients.

Area of Science:

  • Cardiology
  • Neurology
  • Radiology

Background:

  • Left atrial appendage (LAA) slow-flow is a potential risk factor for ischemic stroke.
  • Cardiac computed tomography (CT) can assess LAA blood flow and detect abnormalities.

Purpose of the Study:

  • To investigate the association between LAA slow-flow, identified by cardiac CT, and outcomes in patients with acute ischemic stroke.
  • To compare clinical characteristics, functional outcomes, stroke recurrence, and major adverse cardiovascular events in patients with LAA thrombus, slow-flow, or normal LAA filling.

Main Methods:

  • Prospective cohort study of 421 patients with acute ischemic stroke undergoing cardiac CT.
  • LAA filling defects were categorized as thrombus (<100 HU), slow-flow (≥100 HU), or normal.
  • Outcomes including modified Rankin Scale, stroke recurrence, and major adverse cardiovascular events were assessed over a 2-year follow-up.

Main Results:

  • 7% of patients had LAA thrombus, 16% had slow-flow, and 76% had normal filling.
  • Patients with thrombus or slow-flow had higher rates of atrial fibrillation compared to those with normal filling.
  • LAA thrombus was associated with worse functional outcomes, while slow-flow showed no significant difference in functional outcome or major adverse cardiovascular events compared to normal filling.
  • In cryptogenic stroke patients, slow-flow was associated with an increased risk of stroke recurrence.

Conclusions:

  • LAA slow-flow shares some patient characteristics with LAA thrombus but is associated with less severe strokes.
  • LAA slow-flow is not significantly linked to functional outcome or major adverse cardiovascular events in the general acute ischemic stroke population.
  • LAA slow-flow is an independent risk factor for recurrent stroke specifically in patients with cryptogenic stroke.
Abstract

Keywords:
acute ischemic strokecomputed tomography angiographyfilling defectslow‐flow

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