Left-Sided Atrial Septal Pouch as a Risk Factor of Cryptogenic Stroke: A Systematic Review and Meta-Analysis

Abstract

Background: Despite some evidence of left-sided septal pouch (LSSP) involvement in the pathogenesis of cardioembolic stroke, the question of LSSP clinical significance still remains unsolved. In this study, we aimed to determine the association between the LSSP presence and cryptogenic stroke using meta-analytical approach. Methods: We performed a systematic review of electronic databases for studies that compared the presence of LSSP in subjects with cryptogenic stroke and non-stroke control. Data were extracted and pooled into a meta-analysis. Results: Seven studies (400 cryptogenic stroke patients and 1,456 non-stroke controls) were included in the meta-analysis. A total of 138 LSSPs were identified among the cryptogenic stroke patients, with a pooled prevalence of 29.8% (95% CI 17.5–43.7%), and 268 LSSPs were identified in the non-stroke controls, with a pooled prevalence of 21.0% (95% CI 13.7–29.5%). After meta-analysis, the risk of cryptogenic stroke was higher in patients with an LSSP than in patients without LSSP (OR 1.52; 95% CI 1.15–2.00; p < 0.001). No significant heterogeneity was detected across the included studies (p > 0.05). Conclusion: Our meta-analysis demonstrated association between LSSP and cryptogenic stroke. In our univariate analysis, the risk of cryptogenic stroke is higher among patients with LSSP than in cases without the LSSP.

The left atrial septal pouch‐Dispelling controversies

“…2 The existence of the LASP is a relatively new discovery, and its clinical relevance remains underrated, despite strong evidence for its involvement in the etiology of cerebrovascular events. 3 Unfortunately, due to the novelty of this topic, we are still finding discrepancies and understatements, which appear in the above-mentioned case report, 1 and which, in our opinion, require attention. Authors of this case report pointed out the difference in the prevalence of the LASP, which according to our previous morphological study, is 47%.…”

“…1 However, both original studies and recent meta-analysis have found a strong association between LASP and cryptogenic stroke, where risk for cryptogenic stroke was higher among patients with LASP than in cases without LASP (OR = 1.52; 95% CI = 1.15-2.00; P < .001). 3,7 In the final remarks of the case report by Ohanyan et al, 1 it is suggested that the presence of LASP should be investigated at every transesophageal echocardiography examination, which in the light of the latest studies, 3 should make this procedure routine.…”

Coronary CTA to Investigate Predictive Value of Left Atrial Appendage for Cardiogenic Stroke in Patients with Nonvalvular Atrial Fibrillation

“…When the thrombus in the LAA is organized, detached, and ejected through the left ventricle, it will cause distal arterial embolization of the systemic circulation. About 80% of the embolic events occur in the cerebral blood vessels, leading to cardiogenic stroke [ 21 ]. Changes in the structure and function of the LAA affect not only the occurrence of stroke but also the progression and prognosis of stroke [ 22 , 23 ].…”

Left atrial septal pouch as cause of cryptogenic stroke: Where do we stand?

“…Few studies tried to demonstrate correlation between the presence of a LASP and cryptogenic stroke, but as a matter of fact the results are controversial . The cited meta‐analysis and original studies certainly represent valid work and a starting point of discussion .…”

“…Few studies tried to demonstrate correlation between the presence of a LASP and cryptogenic stroke, but as a matter of fact the results are controversial . The cited meta‐analysis and original studies certainly represent valid work and a starting point of discussion . Nevertheless the retrospective method, a quite heterogeneous data collection and case–control selection modality throughout the studies taken into account and the limited size of the sample in the original study represent substantial weaknesses that might affect the consistency of the message.…”