Citations 2
Abstract A029: Diagnostic Yield of Cardiac CT to Detect Cardiac Thrombi in Acute Ischemic Stroke: an Individual Patient Data Meta-Analysis.
Nio, Shan Sui , Green, Daniel B. , Berry, Alexander , Rinkel, Leon A, Planken, R. Nils, Randen, Adriënne van , Hilt, Mirre , Ruhe, Deborah, Bouma, B., Boekholdt, S, Chew, Beng Lim Alvin , Fridgant, Joshua, ROMO, LUIS MENA, Guo, Shuyu, Winders, Joel, Senadeera, Sajith C. , Lim, Anthony , Fink, John , Leung, Melissa , Parsons, Mark, Spratt, N., Garcia-Esperon, Carlos, Wu, Teddy, Coutinho, Jonathan M. , Green, Daniel, Rinkel, Leon A. , Beemsterboer, Chiel F.P. , Hasnain, Md Golam , Planken, R. Nils , Boekholdt, S. Matthijs , Romo, Luis Mena, Kim, Dong Hyun , Alamri, Yassar , Lim, Anthony T , Leung, Melissa , Cordato, Dennis , Spratt, Neil J , Garcia-Esperon, Carlos , Wu, Teddy Y
Stroke | January 29, 2026 | Volume: 57 | Issue: Suppl_1 | Pages: No page available
Background: Cardiac CT acquired during the acute stroke imaging protocol is an emerging diagnostic modality to detect cardiac thrombi. We aimed to determine its diagnostic yield in a large, international, multicenter study. Methods: We performed an individual patient data meta-analysis by pooling prospective and retrospective observational data of patients with acute ischemic stroke (AIS) who underwent cardiac CT (ECG-gated or non-ECG-gated) as part of the acute imaging protocol between May 2018 and June 2024. We excluded patients with a TIA or stroke mimic. The primary outcome was the proportion of patients with a cardiac thrombus detected on cardiac CT. Secondary outcomes were additional scan time and radiation dose, comparison of yield with echocardiography, and 90-day mortality and recurrent ischemic stroke rates. Results: We included 3940 patients from 4 hospitals (median age 74 [IQR 63-82], 58.0% male, median NIHSS 6 [IQR 3-12], median time onset to hospital arrival 100 minutes [IQR 62-185]). Atrial fibrillation at baseline was present in 23.1% patients, and 29.6% had a large vessel occlusion. Cardiac CT was non-diagnostic in 17 (0.4%) patients. In total, cardiac CT detected 254 cardiac thrombi in 243/3923 (6.2%) patients. Thrombi were located in the left atrial appendage (n=193), left atrium (n=19), and left ventricle (n=42). Of 95/243 (39.1%) patients with a cardiac thrombus that underwent echocardiography (median interval cardiac CT-echocardiography: 2 days), transthoracic echocardiography detected a thrombus in 18/92 (19.6%) patients and transesophageal echocardiography in 2/5 (40.0%) patients. The diagnostic yield in patients that underwent both modalities was higher for cardiac CT (OR 7.5 [CI 4.0-15.3], p<0.001). Median additional scan time was 6 minutes (IQR 5-7) for ECG-gated and 17 seconds (IQR 15-63) for non-ECG-gated cardiac CT. Median additional radiation dose was 5.4mSv (IQR 3.0-7.6). Patients with a cardiac thrombus on cardiac CT had higher 90-day mortality than those without a thrombus (33.3% vs 14.6%, p<0.001). We found no difference in 90-day recurrent stroke rate (5.4% vs 4.4%, p=0.50). Conclusion: Routine cardiac CT performed during the acute stroke imaging protocol detects a cardiac thrombus in 1 out of 16 patients with AIS, with a 7-times higher yield than routine echocardiography. Mortality rate was doubled in patients with a cardiac thrombus, but 90-day stroke recurrence risk did not differ.
Abstract DP126: ECG-gated versus non-ECG-gated cardiac CT protocols for cardiac thrombus detection in acute ischemic stroke.
ROMO, LUIS MENA, Nio, Shan Sui , Berry, Alexander , Spratt, N., Green, Daniel, Hasnain, Md, Chew, Beng Lim Alvin , Fridgant, Joshua, Rinkel, Leon A, Beemsterboer, Chiel, Planken, R. Nils, Randen, Adriënne van , Hilt, Mirre, Ruhe, Deborah, Bouma, B., Boekholdt, S, Kim, Dong Hyun, Guo, Shuyu, Winders, Joel, Senadeera, Sajith C. , Lim, Anthony , Fink, John , Leung, Melissa, Parsons, Mark, Wu, Teddy, Coutinho, Jonathan, Garcia-Esperon, Carlos, Romo, Luis Mena, Spratt, Neil J , Hasnain, Md Golam , Rinkel, Leon A. , Beemsterboer, Chiel F.P. , Planken, R. Nils , Hilt, Mirre , Boekholdt, S. Matthijs , Alamri, Yassar , Lim, Anthony T , Cordato, Dennis , Parsons, Mark W , Wu, Teddy Y , Garcia-Esperon, Carlos
Stroke | January 29, 2026 | Volume: 57 | Issue: Suppl_1 | Pages: No page available
Background: The rate of intracardiac thrombus detection in the hyperacute phase of stroke varies from 5% to 12% between studies. Our aim was to compare the thrombus detection rate between ECG-gated and non-ECG-gated cardiac CT protocols in acute stroke patients, using data from a large, international, multicentre registry. Methods: We conducted an individual patient data meta-analysis by pooling prospective and retrospective observational data from stroke patients assessed at four comprehensive stroke centres who underwent either ECG-gated or non-ECG-gated cardiac CT (extended CT angiography or two-phase non-ECG-gated cardiac CT) as part of the acute stroke imaging protocol between May 2018 and June 2024. The primary outcome was the proportion of patients with a cardiac thrombus in gated vs non gated techniques. Results: Of 3,940 patients, 1,474 (37.4%) underwent ECG-gated and 2,466 (62.6%) non-ECG-gated cardiac CT. Patients in the ECG-gated group were younger (median age 72 [IQR 62–81] vs. 74 [IQR 64–82] years, p = 0.000) and had a lower NIHSS at baseline (median 5 [IQR 2–12] vs. 6 [IQR 3–13], p < 0.00). There was a higher rate of thrombus detection with ECG-gated CT compared to non-gated CT (7.5% vs. 5.5%, p = 0.011. The association remained significant after adjusting for age, sex, baseline NIHSS score, and baseline atrial fibrillation (adjusted OR 1.87, 95% CI 1.42–2.47, p = 0.000). ECG-gated CT was associated with lower radiation dose (3.6 vs. 6.3 mSv, p = 0.000) but longer acquisition time (5.8 vs. 0.28 min, p = 0.000). Conclusion: ECG-gated cardiac CT has a higher detection rate for intracardiac thrombus detection compared to non-ECG-gated CT in patients with acute ischemic stroke.