Poor enhancement pattern of left atrial appendage in cardiac computed tomography is associated with stroke in persistent atrial fibrillation patients.

Poor enhancement pattern of left atrial appendage in cardiac computed tomography is associated with stroke in persistent atrial fibrillation patients. J Thorac Dis. 2019 Aug;11(8):3315-3324 Authors: Inoue T, Suematsu Y Abstract Background: In atrial fibrillation (AF) patients, the left atrial appendage (LAA) is the major source of thrombi. We assessed the hypothesis that poor contrast enhancement in the LAA during the early phase of cardiac computed tomography (CT) predicts a high risk of thrombus formation, leading to cardiogenic stroke. Methods: We studied 147 consecutive patients with chronic AF who underwent cardiac CT. Three different patterns of medium contrast enhancement in the LAA were used to categorize the stroke risk: poor, intermediate, and good enhancement pattern. Results: The CT scans of 147 patients were analyzed (age, 69±9 years; 82% men; 43% with a CHA2DS2-VASc score ≥2). Seventy-two patients (49%) had a poor enhancement LAA enhancement pattern, 33 (22%) had an intermediate enhancement pattern, and 42 (29%) had a good enhancement pattern. Of the 147 patients, 58 (39%) had a history of ischemic stroke or transient ischemic attack (TIA). The prevalence of a stroke history associated with each pattern was 58%, 27%, and 17%, respectively (P
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research

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This study assesses the current practices of physicians in Lebanon routinely involved in ischemic stroke (IS) management. We conducted a prospective observational study of patients hospitalized at 8 different Lebanese hospitals in the period August 1, 2015 to July 31, 2016, with a diagnosis of acute stroke. Baseline characteristics and data on diagnostic studies, as well as treatments received during hospitalization and at discharge, were collected and analyzed. Two hundred and three strokes/transient ischemic attacks (TIAs) were recorded but only 173 patients (85%) with ischemic events were included in the study. The pati...
Source: Functional Neurology - Category: Neurology Tags: Funct Neurol Source Type: research
Emilio Rodríguez-Castro1,2, Manuel Rodríguez-Yáñez1,2, Susana Arias1,2, María Santamaría1,2, Iria López-Dequidt1,2, Ignacio López-Loureiro1, Manuel Rodríguez-Pérez1, Pablo Hervella1, Tomás Sobrino1, Francisco Campos1, José Castillo1* and Ramón Iglesias-Rey1* 1Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain2Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Johannes Schurig1,2*, Karl Georg Haeusler1,2,3, Ulrike Grittner4,5, Christian H. Nolte1,2, Jochen B. Fiebach1,2, Heinrich J. Audebert1,2, Matthias Endres1,2,5,6 and Andrea Rocco1,2 1Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany 2Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany 3Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany 4Insitute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany 5Berlin Institute of Heal...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
This study was approved by the ethics committee of the medical faculty of the Ruhr University Bochum. FIGURE 1 Figure 1. Flow chart showing the selection of the study population. Results A total of 59 patients underwent emergency CCTA (Figure 2A) for suspected stroke, of which 44 received the final diagnosis ischemic stroke. There were 17 patients who had ischemic stroke or TIA and known or newly diagnosed atrial fibrillation (Table 1; mean age: 77.5 years, standard deviation: 8.4 years; 53% female). As hypothesized, intracardiac thrombi could be visualized: once in an artificially occluded left atrial appe...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
AbstractWe evaluated the predictive value of several clinical, radiological and laboratory parameters on the risk of predict intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF). We conducted a case-control study on a consecutive hospital based series of patients with AF and ICH. A random sample of subjects with AF without ischemic or hemorrhagic stroke was selected from the same hospital in the same period to perform as the control group, with a ratio of two controls per case. All patients underwent the same evaluation protocol. Patients without neuroimaging exams were excluded. During the study period ...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Conclusions: Our study is the largest study examining morbidly obese patients on DOACS and provides further evidence of comparable efficacy and safety of the direct oral anti-Xa inhibitors, compared to warfarin, in morbidly obese patients with AF and VTE.DisclosuresKushnir: Janssen: Research Funding. Billett: Bayer: Consultancy; Janssen: Research Funding.
Source: Blood - Category: Hematology Authors: Tags: 332. Antithrombotic Therapy: Management of Challenging Patients and Scenarios Source Type: research
ConclusionsFor AF patients with low risk of stroke, when MDCT images showed no filling defect in the late phase, TEE prior to catheter ablation can be avoided.Key Points•MDCT can help detect the presence of LAA thrombus.•TEE can be avoided when late-phase MDCT shows no filling defect.•TEE is required in patients whose MDCT images indicate thrombus.
Source: European Radiology - Category: Radiology Source Type: research
AbstractRationale:To date, the only treatment approved for acute ischemic strokes is thrombolysis. Whether intravenous thrombolysis may be safe in patients taking direct oral anticoagulants (DOACs) is currently a matter of debate.Patient concerns:A 74-year-old woman, who was on rivaroxaban 20 mg/d for nonvalvular atrial fibrillation, was admitted to our stroke unit with left-sided hemiparesis and aphasia. The onset of neurologic deficits had occurred 5 hours after the last rivaroxaban dose.Diagnosis:An acute ischemic stroke was diagnosed.Interventions:The patient was administered thrombolytic treatment with intravenous r...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
AbstractDirect oral anticoagulants (DOACs) are superior to warfarin in reduction of the intracranial bleeding risk. The aim of the present study was to assess whether early DOAC introduction (1 –3 days after onset) in stroke patients with non-valvular atrial fibrillation (nVAF) may be safe and effective, compared with DOAC introduction after 4–7 days. We conducted a prospective analysis based on data collected from 147 consecutive nVAF patients who started DOAC within 7 days after stro ke onset. In all patients, we performed pre-DOAC CT scan 24–36 h after onset and follow-up CT scan at 7 days after D...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
CONCLUSION: Bilateral thalamic stroke due to artery of Percheron occlusion is a rare presentation of stroke, which can be overlooked in routine CT scan. If diagnosed, it requires further evaluation for stroke risk factors, especially cardiovascular disorders associated with increased embolic risk. PMID: 27154444 [PubMed - as supplied by publisher]
Source: Neurologia i Neurochirurgia Polska - Category: Neurology Authors: Tags: Neurol Neurochir Pol Source Type: research
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