ISC 2026 | Individual patient data meta-analysis of cardiac CT yield for detecting thrombi in AIS
Jonathan Coutinho, MD, PhD, Amsterdam University Medical Center, Amsterdam, The Netherlands, discusses an individual patient data meta-analysis of the diagnostic yield of cardiac CT to detect cardiac thrombi in acute ischemic stroke (AIS). Prof. Coutinho reports a detection rate of around 6% in a combined dataset of nearly 4,000 patients from four hospitals. This interview took place at the 2026 International Stroke Congress (ISC), held in New Orleans, LA.
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Transcript
Yeah, so what we did is we pulled together the data from four hospitals, one in Europe, three in Australia and New Zealand, that have been doing cardiac CT routinely in patients with acute ischemic stroke in the acute phase, so in the acute imaging protocol. And we combined all the data to see how often do we detect thrombi in these patients on cardiac CT. And overall the proportion is around 6% so a little higher but around 6% of patients we find a cardiac thrombus usually in the left atrial appendage sometimes it’s in the left atrium and in rare situations in the left ventricle...
Yeah, so what we did is we pulled together the data from four hospitals, one in Europe, three in Australia and New Zealand, that have been doing cardiac CT routinely in patients with acute ischemic stroke in the acute phase, so in the acute imaging protocol. And we combined all the data to see how often do we detect thrombi in these patients on cardiac CT. And overall the proportion is around 6% so a little higher but around 6% of patients we find a cardiac thrombus usually in the left atrial appendage sometimes it’s in the left atrium and in rare situations in the left ventricle. So yeah, around 6%. What we find is that in certain patient groups, this proportion is higher. So for instance, patients with atrial fibrillation, it’s slightly higher. It’s higher in patients with more severe strokes, with large vessel occlusions. So there’s all kinds of ways to stratify the data. But if you take all ischemic stroke patients combined, it’s around 6%. Now, this was the data of almost 4,000 patients. We also compared how well it behaves, cardiac CT, in detecting cardiac thrombi compared to the standard of care, which in most centers is TTE, so transthoracic echocardiography. Now, this wasn’t available for all patients. It was only routinely done in one-third of patients, which is low, but it also shows the problem of routine TTE. It simply is not done in every patient. That’s a consistent thing that we’re seeing in other centers as well. But still, we have data of around 1,300 patients that underwent both cardiac CT and TTE. And if you compare those, you can see that the detection rate of cardiac CT, defined cardiac thrombi, is around seven times higher compared to TTE.
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