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Cardiac CT in Large Vessel Occlusion Stroke for the Evaluation of Non-Thrombotic and Non-Atrial-Fibrillation-Related
Karim Mostafa1, Cosima Wünsche1, Sarah Krutmann2
1Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Street 3, 24105 Kiel, Germany.
Insights
Cardiac CT (cCT) in large vessel occlusion (LVO) stroke patients identified key indicators of cardioembolic sources (CES). Findings like left ventricular dilation and aortic arch atheroma predict stroke causes beyond atrial fibrillation (AF) or thrombi.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Large vessel occlusion (LVO) stroke necessitates identifying cardioembolic sources (CES).
- Distinguishing CES from other stroke etiologies is crucial for targeted treatment.
- Cardiac CT (cCT) offers potential for acute-phase evaluation of CES.
Purpose of the Study:
- To evaluate acute-phase cardiac CT (cCT) findings in LVO stroke patients.
- To identify potential cardioembolic sources (CES) excluding atrial fibrillation (AF) and intracardiac thrombi.
- To determine imaging markers associated with CES in this patient cohort.
Main Methods:
- Retrospective analysis of 315 LVO patients undergoing acute cCT.
- Assessment of 15 imaging findings linked to cardioembolic risk factors.
- Multivariate regression analysis to identify independent predictors of CES.
Main Results:
- A cardioembolic etiology was identified in 70% of cases.
- Left ventricular dilation (AOR 32.4), right-to-left interatrial shunt (AOR 30.8), and valve implants (AOR 24.5) were significant CES predictors.
- Aortic arch atheroma > II (AOR 6.9) and myocardial scars (AOR 6.3) also correlated with CES.
Conclusions:
- In LVO stroke patients without AF or thrombi, specific cCT findings indicate CES.
- Left ventricular dilation, interatrial shunts, valve implants, and aortic atheroma are key indicators.
- These findings warrant additional evaluation in acute-phase cCT for stroke etiology determination.
Abstract:
Background: The purpose of this study is the evaluation of imaging findings of acute-phase cardiac CT (cCT) in stroke patients with large vessel occlusion (LVO) to identify potential cardioembolic sources (CES) in patients without intracardiac thrombi and atrial fibrillation (AF). Material and Methods: This retrospective study included 315 patients with LVO who underwent cCT imaging in the acute stroke setting. The images were analysed for 15 imaging findings following the established minor and major cardioembolic risk factors. The final stroke aetiology was determined using the TOAST classification through interdisciplinary consensus following a thorough clinical evaluation. Multivariate regression analysis was performed to identify imaging findings associated with CES. Results: A cardioembolic aetiology was identified on cardiac CT in 211 cases (70%). After adjustment for AF and intracardiac thrombi, the multivariate regression analysis revealed significant associations with left ventricular dilation (adjusted odds-ratio (AOR) 32.4; 95% CI 3.0-349; p = 0.004), visible interatrial right-to-left shunt (AOR 30.8; 95% CI 2.7-341.3; p = 0.006), valve implants (AOR 24.5; 95% CI 2.2-270.9; p = 0.009), aortic arch atheroma grade > II (AOR 6.9; 95% CI 1.5-32.8; p = 0.015) and post-ischaemic myocardial scars (AOR 6.3, 95% CI 1.2-34.1; p = 0.032) as independent risk factors for a cardioembolic aetiology. The combined model achieved an area under the ROC curve of 0.83. Conclusions: In patients with LVO without AF and intracardiac thrombi as a cause, the presence of left ventricular dilatation, interatrial right-to-left shunts, valve implants, post-ischaemic myocardial scarring and advanced aortic arch atheroma (grade > 2) in particular is significantly associated with a cardioembolic cause of stroke and should be add-on evaluated in acute-phase cCT. Further investigations are warranted to confirm these associations.
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