Ischemic stroke stroke
Conditions
Interventions
None listed
Sponsors
Amsterdam UMC
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: Population (base) Patients 18 years or older with acute ischemic stroke and a left atrial thrombus detected on cardiac CT acquired during the initial stroke imaging protocol at Amsterdam UMC, location AMC. Inclusion criteria In order to be eligible to participate in this study, a subject must meet all of the following criteria: • Age 18 years or older • Clinical diagnosis of acute ischemic stroke • Written informed consent from patient or representative • Radiological diagnosis of cardiac thrombus in the LA, including the LAA, on cardiac CT acquired during the initial stroke imaging protocol.
Exclusion criteria
Exclusion criteria: A potential subject who meets any of the following criteria will be excluded from participation in this study: • Patients with a diagnosis other than acute ischemic stroke, such as: transient ischemic attack, intracerebral haemorrhage, subarachnoid haemorrhage, epilepsy, tumor. • Absolute contraindication for TEE: o Perforated viscus o Esophageal stricture o Esophageal tumor o Esophageal perforation, laceration o Esophageal diverticulum o Active upper GI bleed • Absolute contraindication for repeat cardiac CT o Documented previous severe reaction to iodinated contrast media, including anaphylaxis, angioedema and bronchospasm. o Severely impaired kidney function defined as estimated glomerular filtration rate of 30 mL/min/1.73 m2.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1) Rate at which LA thrombi visualized on acute cardiac CT dissolve in the first days after ischemic stroke. 2) False-positive rate for detection of left atrial thrombi on acute cardiac CT compared to TEE. | — |
Secondary
| Measure | Time frame |
|---|---|
| - Secondary outcomes include other pre-defined high-risk and non-high-risk sources of embolism on cardiac CT and TEE, which will also be systematically assessed according to predefined criteria.These sources of embolism are: o Left ventricular thrombus, o Prosthetic valve abnormalities (pannus or thrombus), o Signs of endocarditis (e.g., valvular vegetations), o Atrial myxoma, o Papillary fibroelastoma, o Sign of myocardial infarction, o Signs of rheumatic valvular disease (mitral stenosis), o Left atrial appendage morphology, o Left atrial appendage slow-flow, o Left atrial (appendage) volume, o Atrial diverticulum, o Left ventricular apical aneurysm, o Patent foramen ovale, o Atrial septal defect, o Aortic atherosclerotic plaque, including size, ulceration and composition - We will assess the clinical impact of detecting cardiac thrombi and other sources of embolism on acute cardiac CT and TEE, including any impact on stroke etiology according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.3 Any complications resulting from cardiac CT (i.e. contrast allergy and contrast induced nephropathy) and TEE will be recorded. | — |
Countries
Netherlands
Outcome results
None listed