Vascular imaging in the initial evaluation of embolic stroke source

Area of Science:

• Neurology
• Vascular Medicine
• Radiology

Background:

• Acute ischemic stroke evaluation frequently utilizes neurovascular imaging.
• Identifying the thromboembolus source and vascular stenoses is crucial for treatment.

Purpose of the Study:

• To assess the utility of intracranial/cervical CTA, MRA, and carotid Doppler ultrasound (DUS) in identifying stroke sources.
• To determine the incidence of vascular stenoses across different stroke etiologies.

Main Methods:

• Retrospective review of neurovascular imaging (CTA, MRA, DUS) in 200 acute stroke patients.
• Stroke etiology classification using Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria.
• Stratification of intracranial and cervical vascular stenosis rates by stroke type.

Main Results:

• Small vessel disease (29%), cardioembolic (26%), and atheroembolic (23.5%) were the most common stroke sources.
• 27.5% of patients exhibited ≥70% stenosis on neurovascular imaging.
• Neck stenosis rates were 6.9% for small vessel disease and 5.8% for cardioembolic strokes.

Conclusions:

• Stroke etiologies were similarly distributed among TOAST categories.
• Neurovascular imaging demonstrated high utility for detecting intracranial large vessel stenoses.
• Neck CTA/MRA showed lower positive yield for cardioembolic and small vessel disease strokes, impacting acute stroke work-up strategies.