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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.
Insights
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.
Background:
Cardiac computed tomography (CT) is increasingly used to search for cardioembolic sources of acute ischemic stroke (AIS). We assessed the association between high-risk cardioembolic sources on cardiac CT and AIS.
Methods:
We performed a case-control study using data from a prospective cohort including consecutive adult patients with suspected stroke who underwent cardiac CT acquired during the initial stroke imaging protocol between 2018 and 2020. Cases were patients with a final diagnosis of AIS. Controls were patients with a stroke mimic (SMi). We excluded patients with a transient ischemic attack. Diagnoses were established by an adjudication committee. Cardiac radiologists assessed the presence of structural high-risk sources of cardioembolism according to predefined criteria. We used the Firth penalized likelihood method to perform a logistic regression, adjusted for age, sex, and history of myocardial infarction to determine the association between high-risk embolic sources and AIS. For the primary analysis, we excluded patients with a history of atrial fibrillation. In a secondary analysis, patients with known atrial fibrillation were included.
Results:
Of 774 patients, we excluded 167 patients due to no written informed consent or the diagnosis of transient ischemic attack. Of 607 patients, 107 patients had known atrial fibrillation and were excluded from the primary analysis. Of 500 included patients, 375 had AIS (75%, median age 70, 61% male) and 125 SMi (25%, median age 69, 42% male). A high-risk cardioembolic source was found on CT in 32/375 (8.5%) patients with AIS and 0/125 (0%) patients with SMi (adjusted odds ratio, 23.8 [95% CI, 3.3-3032.5]). Cardiac thrombi were the most commonly observed abnormality, present in 23 (6.1%) patients with AIS and 0 (0%) patients with SMi.
Conclusions:
A high-risk source of cardioembolism was detected on cardiac CT more frequently in patients with AIS than in patients with SMi. These data substantiate the clinical relevance of cardioembolic sources detected on acute cardiac CT in patients with ischemic stroke.
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