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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
CT Angiography of the Heart and Aorta in TIA and Ischaemic Stroke: Cardioembolic Risk Sources and Clinical
Ghislaine Holswilder1, Marieke Jh Wermer2, Eduard R Holman3
1Department of Radiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, the Netherlands.
Insights
CT-angiography of the heart and aorta effectively detects cardioembolic sources in TIA/stroke patients. This imaging led to therapeutic changes in 6% of ischemic stroke cases, improving stroke management.
Area of Science:
- Cardiovascular Imaging
- Neurology
- Radiology
Background:
- Cardiac emboli are a primary cause of ischemic stroke and stroke recurrence.
- Atherosclerosis in the aorta is also linked to increased stroke recurrence risk.
- The diagnostic yield of CT-angiography (CTA) of the heart and aorta for TIA/stroke patients requires evaluation.
Purpose of the Study:
- To assess the diagnostic yield of cardiac and aortic CT-angiography (CTA) in patients with transient ischemic attack (TIA) or ischemic stroke.
- To evaluate the clinical implications and impact on therapeutic management of findings from cardiac and aortic CTA.
Main Methods:
- CTA of the heart and aortic arch was performed in TIA/ischemic stroke patients alongside routine diagnostics.
- Assessment included the identification of cardioembolic (CE) risk sources and complex aortic plaques.
- The impact of cardiac CTA findings on patient treatment strategies was analyzed.
Main Results:
- Of 67 included patients (33 TIA, 34 stroke), 43% had CE risk sources detected.
- Intracardiac thrombus was found in 3% of patients (6% of stroke patients).
- Complex aortic plaque was identified in 24% of patients; 2 patients with intracardiac thrombus shifted from antiplatelets to anticoagulation.
Conclusions:
- CTA of the heart and aorta demonstrates high efficacy in identifying embolic sources in TIA/stroke patients.
- Findings have clinical consequences, impacting treatment for approximately 6% of ischemic stroke patients.
- Implementing cardiac and aortic CTA in acute stroke care appears valuable, though cost-effectiveness needs further study.
Background:
Cardiac emboli are important causes of (recurrent) ischaemic stroke. Aorta atherosclerosis might also be associated with an increased risk of stroke recurrence. This study aimed to evaluate the yield and clinical implications of CT-angiography (CTA) of the heart and aorta in the diagnostic workup of transient ischaemic attack (TIA) or ischaemic stroke.
Methods:
CTA of the heart and aortic arch was performed in TIA/ischaemic stroke patients, in addition to routine diagnostic workup. Occurrence of cardioembolic (CE) risk sources and complex aortic plaques were assessed. Implications of cardiac CTA for therapeutic management were evaluated RESULTS: Sixty-seven patients were included (TIA n = 33, ischaemic stroke n = 34) with a mean age of 68 years (range 51-89) and median NIHSS of 0 (interquartile range 0-2). CE risk sources were detected in 29 (43%) patients. An intracardiac thrombus was present in 2 patients (3%; TIA 0%; ischaemic stroke 6%). Medium/low-risk CE sources included mitral annular calcification (9%), aortic valve calcification (18%) and patent foramen ovale (18%). Complex aortic plaque was identified in 16 patients (24%). In two patients with an intracardiac thrombus, therapeutic management changed from antiplatelet to oral anticoagulation.
Conclusions:
CTA of the heart and aorta has a high yield for detection of embolic risk sources in TIA/ischaemic stroke, with clinical consequences for 6% of ischaemic stroke patients. Implementation of CTA of the heart and aorta in the acute stroke setting seems valuable, but cost-effectiveness of this approach remains to be determined.
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