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Background <p>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.</p> Methods <p>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.</p> Results <p>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, <i>p</i> &lt; 0.01), higher mortality (29% vs. 6%, <i>p</i> &lt; 0.01), and more pre-existing heart disease (74% vs. 27%, <i>p</i> &lt; 0.01) and known atrial fibrillation (AF) (63% vs. 8%, <i>p</i> &lt; 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%, <i>p</i> = 0.02). Prior AF was the only independent predictor of thrombus-suggestive filling defect, which was observed despite high rates of anticoagulation (50%).</p> Conclusions <p>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.</p>

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Extended CTA scan range for early detection of left atrial and left atrial appendage thrombus and other filling defects in acute ischemic stroke

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月24日

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  • Juan Marta-Enguita,
  • Sara Biain,
  • Diego Ayuso,
  • Sergio Vasquez-Ferreccio,
  • Cristina del Bosque,
  • Patricia de la Riva,
  • Noemí Diez,
  • Felix Gonzalez,
  • Ana de Arce,
  • Jon Equiza,
  • Gorka Arenaza,
  • Virginia Gomez-Usabiaga,
  • Maite Martinez‑Zabaleta

摘要

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.