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February 2, 2026Stroke

Cardiac CT detects ~7.5x more cardiac thrombi than echocardiography in acute ischemic stroke.

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Why the study?

Cardiac CT during acute stroke imaging is an emerging modality to detect cardiac thrombi, but its diagnostic yield needed determination in a large, international, multicenter study.

Does cardiac CT improve the detection of cardiac thrombi compared to echocardiography in patients with acute ischemic stroke?

Population

3940 patients with acute ischemic stroke from 4 hospitals

Comparison

Cardiac CT vs echocardiography

Design

Individual patient data meta-analysis of prospective and retrospective observational data

Follow-up

90-day

Key result

Cardiac CT during the acute stroke imaging protocol detected cardiac thrombi in 6.2% of patients, with a higher diagnostic yield than echocardiography (OR 7.5; 95% CI 4.0-15.3; P<0.001).

Authors

SNShan Sui NioDGDaniel B. GreenABAlexander Berry

Discussion

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Overview

May enhance thrombus detection in acute ischemic stroke; extends observational data but leaves clinical impact and practice change open.

Key Points

  • To assess the effectiveness of cardiac CT in detecting thrombi in patients with acute ischemic stroke.
  • Conducted an individual patient data meta-analysis of acute ischemic stroke patients.
  • Included prospective and retrospective observational data from multiple centers.
  • Measured primary outcome as the proportion of patients with detected cardiac thrombi.
  • Analyzed additional scan time and radiation exposure, comparing with echocardiography.
  • Cardiac CT detected 254 thrombi in 6.2% of patients.
  • Yield of cardiac CT was seven times higher than echocardiography.
  • Patients with thrombi had a 33.3% mortality rate compared to 14.6% without.
  • No significant difference in 90-day recurrent stroke rates was found.

Study Design

Type

Meta-Analysis (n=3,940)

Multicenter

Yes

Structured PICO

Does cardiac CT improve the detection of cardiac thrombi compared to echocardiography in patients with acute ischemic stroke?

P
Population
3,940 patients with acute ischemic stroke who underwent cardiac CT as part of the acute imaging protocol, evaluated for cardiac thrombi and followed for 90 days.
E
Exposure
Cardiac CT (ECG-gated or non-ECG-gated) performed as part of the acute stroke imaging protocol
C
Comparator
Routine echocardiography (transthoracic or transesophageal) in a subset of patients
O
Outcome
Proportion of patients with a cardiac thrombus detected on cardiac CTsurrogate

Routine cardiac CT during acute stroke imaging provides a 7-times higher diagnostic yield for detecting cardiac thrombi compared to routine echocardiography.

Cite This Study

Nio et al. (2026) conducted a meta-analysis in acute ischemic stroke (AIS) (n=3,940). Cardiac CT vs. Echocardiography was evaluated on proportion of patients with a cardiac thrombus detected on cardiac CT. Cardiac CT during the acute stroke imaging protocol detected cardiac thrombi in 6.2% of patients, with a higher diagnostic yield than echocardiography (OR 7.5; 95% CI 4.0-15.3; P<0.001).

synapsesocial.com/papers/6980fbbec1c9540dea80d800https://doi.org/10.1161/str.57.suppl_1.a029
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