Left-Sided Atrial Septal Pouch and Risk of Cryptogenic Stroke

Abstract

Introduction: Stroke is the second most cause of death worldwide after coronary artery disease. Left-sided atrial septal pouch (LASP) is associated with potential cardioembolic stroke. This study determines the association between LASP and cryptogenic stroke (CS) using cardiac multi-detector computed tomography (cMDCT) angiograms.

Materials and methods: This study included 40 patients with CS (23 males, mean age: 403 +/- 10.4 years) and 40 age- and sex matched healthy controls. cMDCT examinations by dual-source 64-slice MDCT with 0.6-mm slice thickness were performed for all patients and controls. The association between LASP and risk of CS was assessed after adjustment for other stroke risk factors.

Results: Patients with LASP were younger than control subjects (41.3 +/- 7.2 years vs 44.2 +/- 5.7 years; p = 0.066), with a comparable prevalence of hypertension (42.5% vs 35%; p = 0.491) and other risk factors. There were no differences in the prevalence of LASP between patients and controls (32.5% vs 25%; p = 0.621). LASP was observed in 43.5% (n = 10) of normotensive stroke patients compared to 15.4% (n = 4) of normotensive controls (Odds Ratio (OR): 4.23, 95% CI: 1.09-16.27, p = 0.063). On the other hand, LASP was detected in 17.6% (n = 3) of hypertensive CS patients compared to 42.9% (n = 6) of hypertensive controls (OR: 028, 95% CI: 0.05-4.23, p = 0.253). The presence of LASP was not associated with an increased risk of CS.

Conclusion: This study suggests that LASP is associated with CS. However, in normotensive individuals, LASP may be a minor risk factor for CS.