Abstract Body: Introduction
The anterior choroidal artery (AChA) is an artery that typically originates from the internal carotid artery and supplies areas including the posterior limb of the internal capsule, optic tract, and lateral geniculate body. The etiology of AChA infarcts remains poorly understood. Advanced cardiac workup (ACW), including transesophageal echocardiogram (TEE) and implantable loop recorder (ILR) are widely considered a crucial element in the ESUS work-up. Due to the uncertainty in etiology of AChA infarcts, appropriate selection of patients to undergo ACW is largely anecdotal. This study aims to evaluate the diagnostic yield of ACW and to identify positive and negative predictors that ACW would uncover etiology in AChA infarcts.
Methods
We conducted a retrospective review of AChA ischemic strokes, admitted to a large urban academic single center from 2011 to 2024. Patient characteristics and imaging findings were analyzed to determine diagnostic yields and to identify positive and negative predictors that ACW would uncover etiology. Data were adjusted for ejection fraction (EF), prior antithrombotic use, and ipsilateral intracranial atherosclerotic diseases (ICAD).
Results
Out of 42 AChA strokes reviewed, 6 patients (14%) were found to have new atrial fibrillation (A fib), with ILR identifying the etiology in 4 cases (9.5%). 29 patients had TEE, no of which identified etiology. The median age of the sample was 57.5 (IQR of 13.5) and 47.6% were female. Baseline characteristics such as diabetes, hypertension, smoking, ipsilateral ICAD, etc. can be seen in the table appendix. Adjusted analysis revealed that EF < 50% is significantly associated with finding an etiology with ILR (p= 0.03). This association is particularly strong when comparing EF between 30-50% to normal EF >50% (p = 0.003). Additionally, prior antithrombotic use is significantly associated with finding new A fib as an etiology for AChA stroke (p = 0.03).
Conclusion
Our data indicate that in AChA stroke, EF < 50% is significantly associated with an increased likelihood that ILR will find an etiology. This significance warrants ILR in patients with even mildly/moderately low EF. Additionally, patients with prior antithrombotic use are more likely to be diagnosed with new A fib during the workup for AChA stroke. No etiology is identified with TEE in this sample and a larger sample size is required to reach a conclusion about the utility of TEE in finding etiology of AChA stroke.