Pulmonary-artery cineangiocardiography to demonstrate cardiac thrombi in patients with cerebral infarction

The usefulness of pulmonary-artery cineangiocardiography (PACAC) to demonstrate intracardiac thrombi in patients with cerebral infarctions of possible embolic origin has been explored. PACAC was performed in 60 patients (mean age 74 years) with sudden onset of permanent neurological deficits in whom CT scan and CSF analyses had excluded intracerebral hemorrhage. Opacification of the left atrium was excellent in 52 (87%) investigations, acceptable in 7 and poor in 1. Among 33 patients with chronic atrial fibrillation, an atrial thrombus was demonstrated in 8 (24%) and a suspected thrombus in 3. Atrial clot was also demonstrated in a patient with intermittent atrial fibrillation. In 4 out of 14 patients with previous myocardial infarction, a ventricular thrombus was demonstrated. Ventricular clots were detected in 2 of 46 patients without known previous myocardial infarction. No major complications occurred during the investigation. PACAC can be to used in the search for atrial or ventricular thrombi when cardiac source of a cerebral embolus is suspected. About 1 out of 3 patients with atrial fibrillation has remaining intracardiac thrombus after stroke.