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Updated: Jun 4, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
High-Risk Embolic Sources on Cardiac Computed Tomography in Patients With Acute Ischemic Stroke: A Case-Control Study
Shan Sui Nio1, Leon A Rinkel1, Joost van Schuppen2
1Departments of Neurology (S.S.N., L.A.R., C.F.P.B., V.G., Y.B.W.E.M.R., J.M.C.), Amsterdam UMC location University of Amsterdam, the Netherlands.
High-risk cardioembolic sources on cardiac CT scans were significantly more common in patients with acute ischemic stroke (AIS) than in those with stroke mimics. This finding highlights the clinical importance of cardiac CT in identifying stroke causes.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Cardiac computed tomography (CT) is increasingly utilized for identifying cardioembolic sources in acute ischemic stroke (AIS).
- Assessing the association between high-risk cardioembolic sources detected via cardiac CT and AIS is crucial for stroke management.
Purpose of the Study:
- To evaluate the association between high-risk cardioembolic sources identified on cardiac CT and the occurrence of AIS.
- To determine the diagnostic value of cardiac CT in differentiating AIS from stroke mimics (SMi) based on cardioembolic source detection.
Main Methods:
- A case-control study was conducted using prospective cohort data from adult patients with suspected stroke undergoing cardiac CT (2018-2020).
- Cases were defined as patients with AIS, and controls were patients with SMi, with transient ischemic attack (TIA) patients excluded.
- Cardiac radiologists assessed high-risk cardioembolic sources using predefined criteria, with logistic regression (Firth penalized likelihood) used for analysis, adjusted for age, sex, and myocardial infarction history.
Main Results:
- Of 500 included patients (375 AIS, 125 SMi), a high-risk cardioembolic source was identified in 8.5% of AIS patients versus 0% of SMi patients (aOR 23.8).
- Cardiac thrombi were the most frequent abnormality, found in 6.1% of AIS patients and none of the SMi patients.
- The analysis excluded patients with atrial fibrillation in the primary assessment, with a secondary analysis including them.
Conclusions:
- High-risk cardioembolic sources are detected more frequently on cardiac CT in patients with AIS compared to those with SMi.
- These findings underscore the clinical significance of identifying cardioembolic sources using acute cardiac CT in patients diagnosed with ischemic stroke.
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