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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mind the Heart: Electrocardiography-gated cardiac computed tomography-angiography in acute ischaemic stroke-rationale
Valeria Guglielmi1, Leon A Rinkel1, Nina-Suzanne Groeneveld1
1Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Electrocardiography-gated cardiac computed tomography-angiography shows promise for detecting cardio-aortic sources of embolism in acute ischemic stroke patients. This advanced imaging may offer a higher diagnostic yield than traditional echocardiography for stroke etiology determination.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Cardioembolism accounts for a significant portion of ischemic strokes.
- Identifying the stroke's origin is crucial for effective management.
- Computed tomography-angiography (CTA) is an emerging alternative to echocardiography for detecting cardio-aortic embolism sources.
Purpose of the Study:
- To evaluate the diagnostic yield of electrocardiography-gated cardiac CTA compared to transthoracic echocardiography in acute ischemic stroke patients.
- To determine if cardiac CTA is a superior first-line screening tool for cardio-aortic embolism sources.
Main Methods:
- Prospective observational cohort study (Mind the Heart) including adult patients with acute ischemic stroke eligible for reperfusion therapy.
- Patients underwent non-ECG-gated CTA of the aorta and head/neck arteries, followed by ECG-gated cardiac CTA.
- Standard cardioembolism work-up, including echocardiography, was performed concurrently.
Main Results:
- The primary endpoint is the proportion of patients with a high-risk cardio-aortic source of embolism detected by CTA versus echocardiography.
- A sample size of 450 patients is required, anticipating a 5% additional yield from CTA.
Conclusions:
- The Mind the Heart study aims to provide a reliable estimate of the diagnostic yield of acute-phase ECG-gated cardiac CTA in ischemic stroke.
- This research will clarify the role of cardiac CTA in identifying cardio-aortic sources of embolism.
Rationale:
About one-third of ischaemic strokes are caused by cardioembolism, and a substantial proportion of cryptogenic strokes likely also originate from the heart or aortic arch. Early determination of aetiology is important to optimise management. Computed Tomography-angiography of the heart is emerging as an alternative to echocardiography to detect cardio-aortic sources of embolism in stroke patients, but its diagnostic yield in acute ischaemic stroke has not been thoroughly assessed.Hypothesis: We hypothesise that electrocardiography-gated computed tomography-angiography of the heart and aortic arch, acquired in the acute phase in patients with ischaemic stroke, has a higher diagnostic yield than transthoracic echocardiography as a first-line screening method for detection of cardio-aortic sources of embolism.
Methods And Design:
Mind the Heart is a single-centre prospective observational cohort study. We will include consecutive adult patients with acute ischaemic stroke who are potentially eligible for reperfusion therapy. Patients undergo non-electrocardiography-gated computed tomography-angiography of the aortic arch, cervical and intracranial arteries, directly followed by prospective sequential electrocardiography-gated cardiac computed tomography-angiography. Routine work-up for cardioembolism including 12-leads electrocardiography, Holter electrocardiography and transthoracic echocardiography is performed as soon as possible. The primary endpoint is the proportion of patients with a predefined high-risk cardio-aortic source of embolism on computed tomography-angiography versus transthoracic echocardiography in patients who underwent both investigations. Based on an expected 5% additional yield of computed tomography-angiography, a sample size of 450 patients is required.
Conclusions:
The Mind the Heart study will generate a reliable estimate of the diagnostic yield of echocardiography-gated cardio-aortic computed tomography-angiography performed in the acute phase of ischaemic stroke.
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