Emerging applications of cardiac coronary computed tomography angiography in acute ischemic stroke: A narrative review

There are close interactions between acute ischemic stroke (AIS) and heart diseases, including heart-to-brain interactions (cardioembolic strokes), brain-to-heart interactions (cardiac complications after AIS), and brain-and-heart interactions (coexisting coronary artery disease in AIS). The heart problems not only add complexity to the etiological diagnosis but also account for a significant proportionate mortality in AIS patients. Cardiac coronary computed tomography angiography (CCTA) is becoming a promising and convenient technique allowing for evaluating both coronary atherosclerosis and cardiac structures or function. This review discussed the emerging clinical applications of CCTA in AIS patients, contributing to comprehensive management for optimizing the treatment of AIS and related heart diseases. Summarily, CCTA has been validated as a trustworthy alternative imaging technique to transesophageal echocardiography for detecting cardioaortic embolism sources for patients with AIS, and incorporating CCTA into the stroke CT imaging protocol during the hyperacute stage for AIS patients eligible for reperfusion therapy seems practical. In addition, as AIS patients had higher cardiovascular risk, the use of CCTA to evaluate coronary stenosis, plaque burden, and high-risk plaque may benefit the treatment and prognosis of some AIS patients, particularly those with any cervicocephalic artery stenosis ≥ 50% and multiple vascular risk factors. CCTA might help achieve a more all-encompassing cardiovascular evaluation for AIS patients with possible cardiac complications. As there were limited reports and literature about the relevant issues, there is a need for targeted studies to assess if CCTA could lead to a more accurate reclassification of the causes of cardiac complications after AIS.