Extending non-ECG-gated computed tomographic angiography to include the heart detected high-risk embolic sources in 15% of acute stroke patients, with minimal radiation increase.
Observational (n=20)
Does extending the coverage of non-ECG-gated CTA to include the heart detect embolic sources in patients with acute ischemic stroke?
Extending non-ECG-gated CTA coverage to include the heart in acute stroke patients can detect high-risk embolic sources without increasing contrast-induced nephropathy risk and with minimal additional radiation.
BACKGROUND AND PURPOSE: axis coverage of a non-ECG-gated computed tomographic angiogram performed in the primary evaluation of acute stroke without increasing the contrast dose. METHODS: Twenty consecutive patients with acute ischemic stroke within the 4.5 hours of symptom onset were prospectively recruited. We increased the longitudinal coverage to the domes of the diaphragm to include the heart. Contrast administration (Omnipaque 350) remained unchanged (injected at 3-4 mL/s; total 60-80 mL, triggered by bolus tracking). Images of the heart and aorta, reconstructed at 5 mm slice thickness in 3 orthogonal planes, were read by a radiologist and cardiologist, findings conveyed to the treating neurologist, and correlated with the transthoracic or transesophageal echocardiogram performed within the next 24 hours. RESULTS: Of 20 patients studied, 3 (15%) had abnormal findings: a left ventricular thrombus, a Stanford type A aortic dissection, and a thrombus of the left atrial appendage. Both thrombi were confirmed by transesophageal echocardiography, and anticoagulation was started urgently the following day. None of the patients developed contrast-induced nephropathy on follow-up. The radiation dose was slightly increased from a mean of 4.26 mSV (range, 3.88-4.70 mSV) to 5.17 (range, 3.95 to 6.25 mSV). CONCLUSIONS: Including the heart and ascending aorta in a routine non-ECG-gated computed tomographic angiogram enhances an existing imaging modality, with no increased incidence of contrast-induced nephropathy and minimal increase in radiation dose. This may help in the detection of high-risk cardiac and aortic sources of embolism in acute stroke patients.
Yeo et al. (Fri,) conducted a observational in Acute ischemic stroke (n=20). Non-ECG-gated computed tomographic angiogram with extended coverage to the heart was evaluated on Detection of abnormal findings (high-risk cardiac and aortic sources of embolism). Extending non-ECG-gated computed tomographic angiography to include the heart detected high-risk embolic sources in 15% of acute stroke patients, with minimal radiation increase.