Transthoracic Echocardiogram v/s Transesophageal Echocardiogram in Identification of Intracardiac Thrombus in Acute Ischemic Stroke Patients (P6.239)

Objective: To investigate the diagnostic yield of transthoracic echocardiogram (TTE) v/s transesophageal echocardiogram (TEE) for detection of intracardiac thrombus in the patient presenting with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) of intracerebral vessels. Background: Cardioembolism represents the second most common cause of AIS which may result due to embolism of left atrial or ventricular thrombus that makes the detection of cardiac sources, a crucial part of the post-stroke evaluation.1 There is considerable disagreement among experts regarding the cost-effective approach for cardiac evaluation and the usefulness of making TEE a part of standard stroke workup.2 Design/Methods: Electronic medical records of Los Robles Hospital and Medical Center (LRHMC) from the period of Jan 2016 – Jun 2017 were reviewed retrospectively. Patients presented with AIS, diagnosed with LVO on cerebral angiography and had an echocardiogram as part of stroke workup, were included in the data analysis. Results: During the selected period, a total of 643 patients were admitted with the diagnosis of AIS, out of which 114 patients were diagnosed with LVO on cerebral angiography. Total of 112 patients had an echocardiogram and was included in the analysis. The mean age was 72.56 and male to female ratio was 50 (44.64%):62 (55.36%). Out of 112, 29 patients had both TTE and TEE. 4 (3.5%) patients were diagnosed with cardiac thrombus, out of which 3 patients had a thrombus in left atrial appendage (LAA) and one had a thrombus in the left ventricle (LV). TTE was negative in those 3 patients with LAA clot and revealed LV clot in only 1 patient. Conclusions: Our data showed a superior diagnostic yield of TEE over TTE for detection of intracardiac thrombus in patients with cerebral LVO. Considering the low incidence of cardiac thrombi, the indication of TEE in all LVO patients is still unclear. Disclosure: Dr. Suriya has nothing to disclose. Dr. Taqi has nothing to disclose. Dr. Adl has nothing to disclose. Dr. Quadri has nothing to disclose. Dr. Sodhi has nothing to disclose. Dr. Mortazavi has nothing to disclose.