Presence of Residual Cardiac Thrombus Predicts Poor Outcome in Cardioembolic Stroke After Reperfusion Therapy

Abstract

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.

Keywords

• cardiac imaging
• cardioembolic stroke
• functional outcome
• thrombolysis
• thrombus