Extended CTA scan range for early detection of left atrial and left atrial appendage thrombus and other filling
Juan Marta-Enguita1,2,3, Sara Biain4, Diego Ayuso4
1Neurology Department, Hospital Universitario Donostia, San Sebastian, Spain. juan.marta@scsalud.es.
Insights
Including the left atrium and appendage in CT angiography detects thrombus, a key factor in cardioembolic stroke. These findings correlate with more severe strokes and higher mortality, guiding early intervention.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- The left atrium (LA) and left atrial appendage (LAA) are primary sites for thrombus formation, often leading to cardioembolic stroke.
- Early detection of embolic sources is crucial for acute stroke management.
Purpose of the Study:
- To evaluate the inclusion of LA/LAA in acute-phase stroke CT angiography (CTA) for early detection of thrombus.
- To assess the clinical significance of identified LA/LAA filling defects.
Main Methods:
- Retrospective review of CTA scans including LA/LAA from December 2020 to November 2021.
- Classification of LA/LAA images into normal filling, non-well-defined defects, and thrombus-suggestive defects.
- Comparison of clinical, demographic, and stroke severity data across groups.
Main Results:
- Among 299 patients, 2% showed thrombus-suggestive defects and 11% non-well-defined defects.
- Both defect groups exhibited more severe strokes (NIHSS 16 vs. 13), higher mortality (29% vs. 6%), and increased rates of heart disease and atrial fibrillation (AF).
- Prior AF was the sole independent predictor of thrombus-suggestive defects, even with anticoagulation.
Conclusions:
- Acute CTA including LA/LAA effectively identifies thrombus-suggestive and non-well-defined filling defects.
- These defects are associated with poorer stroke outcomes and have significant therapeutic implications.
- This imaging approach aids in early risk stratification and management of cardioembolic stroke.
Background:
The left atrium (LA) and left atrial appendage (LAA) are common sites of thrombus formation leading to cardioembolic stroke. We aimed to include LA/LAA in acute-phase stroke CT angiography (CTA) to detect potential embolic sources early.
Methods:
The CTA scan range was extended to include the LA/LAA. We retrospectively reviewed CTAs from patients treated at Donostia University Hospital between December 2020 and November 2021. LA/LAA images were classified as normal filling, non-well-defined filling defect, and thrombus-suggestive filling defect. Clinical, demographic, and stroke severity data were compared across groups.
Results:
Among 299 patients included, 6 (2%) had thrombus-suggestive filling defects, and 32 (11%) had non-well-defined defects. Both groups had more severe strokes (median NIHSS 16 vs. 13, p < 0.01), higher mortality (29% vs. 6%, p < 0.01), and more pre-existing heart disease (74% vs. 27%, p < 0.01) and known atrial fibrillation (AF) (63% vs. 8%, p < 0.01). AF was more frequently diagnosed during follow-up in the non-well-defined filling defect group than in the normal group (50% vs. 19%, p = 0.02). Prior AF was the only independent predictor of thrombus-suggestive filling defect, which was observed despite high rates of anticoagulation (50%).
Conclusions:
Including LA/LAA in acute CTA allows early identification of thrombus-suggestive and non-well-defined filling defects, both linked to worse outcomes and potential therapeutic consequences.
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