Abstract 126: Relationship Between Visceral Infarction and Ischemic Stroke Subtype

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Background: Most cryptogenic strokes are thought to have an embolic source. We sought to determine whether visceral infarcts, which are usually embolic, are associated with cryptogenic stroke.Methods: Among patients prospectively enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR), we selected those with a contrast-enhanced abdominal computed tomography (CT) scan within 1 year of admission. Our primary predictor was stroke subtype, as adjudicated per the TOAST classification. Our outcome measure was renal or splenic infarction, as assessed by a single radiologist blinded to stroke subtype. We used Fisher’s exact test and multiple logistic regression to compare the prevalence of visceral infarcts among patients with cardioembolic stroke, stroke of undetermined etiology, and non-cardioembolic stroke (large- or small-vessel stroke).Results: Among 227 patients with a contrast-enhanced abdominal CT scan, 59 had a visceral infarct (35 with renal infarcts and 27 with splenic). The prevalence of visceral infarction was significantly different among patients with cardioembolic stroke (34.2%; 95% confidence interval [CI], 23.7-44.6%), stroke of undetermined etiology (23.9%; 95% CI, 15.0-32.8%), and stroke from large-artery atherosclerosis or small vessel-occlusion (12.5%; 95% CI, 1.8-23.2%) (P = 0.03). In multiple logistic regression models adjusted for demographics and vascular risk factors, we found significant associations with visceral infarction for both cardioembolic stroke (odds ratio [OR], 3.5; 95% CI, 1.2-9.9) and stroke of undetermined source (OR, 3.3; 95% CI, 1.1-10.5) as compared with the reference group of non-cardioembolic strokes.Conclusions: The prevalence of visceral infarction differs significantly across ischemic stroke subtypes. Cardioembolic and cryptogenic strokes were associated with a higher prevalence of visceral infarcts than non-cardioembolic strokes.

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