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  • Non-gated cardiac CT angiography for detection of cardio-aortic sources of embolism in the acute phase of ischaemic stroke

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Non-gated cardiac CT angiography for detection of cardio-aortic sources of embolism in the acute phase of ischaemic stroke
  1. Valeria Guglielmi1,
  2. Robrecht Nils Planken2,
  3. Casper Mihl3,4,
  4. Sandra Niesen3,
  5. Julie Staals4,5,
  6. Jonathan M Coutinho1,
  7. Alida A Postma3,6
  1. 1 Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  3. 3 Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
  4. 4 Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
  5. 5 Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
  6. 6 School for Mental Health & Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
  1. Correspondence to Dr Alida A Postma, Department of Radiology and Nuclear Medicine, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands; l.jacobi{at}mumc.nl

http://dx.doi.org/10.1136/jnnp-2019-321923

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    Introduction

    Up to one-third of ischaemic strokes are caused by cardioembolism, which can result from atrial fibrillation (AF) or structural abnormalities.1 Establishing cardioembolic stroke aetiology is essential for secondary prevention, but cardiac thrombi may dissolve <2 hours after intravenous thrombolytic therapy (IVT).2 CT angiography (CTA) from aortic arch to intracranial vessels is necessary for patient selection for endovascular treatment (EVT) in most centres. We investigated the diagnostic yield and image quality of extending the non-ECG-gated CTA to include the heart for detection of structural cardio-aortic sources of embolism in the acute phase of ischaemic stroke, defined as within the time window for reperfusion therapy (IVT/EVT).

    Methods

    We performed a single-centre, retrospective analysis of consecutive patients with acute ischaemic stroke with suspected large vessel occlusion (LVO) eligible for EVT who presented to the emergency department of Maastricht University Medical Center between March 2016 and April 2017. Patients underwent a non-contrast CT of the brain. Subsequently, patients with suspected LVO eligible for EVT underwent CT perfusion of the brain, and non-ECG-gated CTA from the heart to the intracranial arteries in the acute phase, as part of standard care. Patients <4.5 hours of onset of stroke without contraindications received IVT, directly after non-contrast CT and before CTA. Patients <6 hours of stroke onset with a National Institutes of Health Stroke Scale score ≥2 and/or disabling neurological deficit were eligible for EVT if LVO was identified …

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    Footnotes

    • Contributors Study design: VG, RNP, CM, JMC, AAP. Study supervision: AAP. Statistical analysis: VG. Imaging protocol data: SN. Initial draft: VG. Revision of the draft for important intellectual content: all authors. Interpretation of results: all authors.

    • Funding VG received research grants from the Royal Netherlands Academy of Arts and Sciences (Van Leersum Grant), Foundation De Drie Lichten, Remmert Adriaan Laan Fund and AMC Young Talent Fund.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The institutional review board of Maastricht University Medical Center approved this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.