What type of LV thrombus carries the highest risk of embolization?

A pedunculated and mobile thrombus in the left ventricle is associated with the highest risk of embolization due to its anatomical characteristics. This type of thrombus has a narrower attachment point (the "peduncle"), allowing for greater mobility within the heart's chambers. Its movement can facilitate dislodgment into the bloodstream, which could lead to an embolic event.

In clinical practice, the understanding of thrombus types is critical as the risk of stroke and other ischemic events is significantly influenced by the nature of the thrombus. Mobile thrombi can detach and travel, potentially causing blockage in cerebral or systemic circulation, in contrast to other types of thrombi that may be more stable or fixed in place, presenting a lower immediate risk for such complications.

Further context regarding the other options reinforces why they carry less risk. Fixed and laminated thrombi tend to be more stable due to their attachment to the endocardium, making them less likely to dislodge. Large and adherent thrombi may also be stable but can still pose a risk under certain circumstances, especially if they develop structural changes. Calcified and stable thrombi are generally less mobile and more integrated into the myocardial tissue, further reducing their risk of generating emboli