Extending the simple CT scan administered to all acute stroke patients to include the upper part of the heart increased cardioaortic thrombus detection by almost sixfold.
ABU DHABI, UAE — Extending the simple CT angiography scan given to all patients with acute stroke on presentation to the hospital to include the upper part of the heart increased the detection of a cardioaortic thrombus by almost sixfold compared with standard care stroke workup, results of a new randomized trial showed.
Sposato explained that most patients undergo a transthoracic echo during hospitalization to look at the heart, but, while this is good at identifying a patent foramen ovale, it has a low diagnostic yield for embolic sources of only around 1%. There have been a few observational studies suggesting that this technique can result in a high detection of clots, but this is the first randomized trial to investigate this approach.
The primary endpoint was the number of patients in whom a clot was detected. This was 1.7% of patients in the standard CTA group vs 8.8% in the extended CTA, giving an odds ratio of 5.7 , which Sposato said was not clinically relevant. “If a patient has had an acute ischemic stroke, and we think it is an embolic stroke from the pattern of blockages in the brain, and we don't have another cause, but we can see clots in the left atrial appendage, then I would have said that the stroke is likely to have been caused by those clots. I would treat with anticoagulation early in order to prevent a second stroke that could occur at any time,” he said.
In this study, slow flow was found in 24.3% of patients who underwent the extended CT, compared with 7.1% in the standard of care group — a fourfold significant increase.“We found things that were not specially looking for. Some patients had a new pulmonary nodule and were diagnosed with cancer, which can now be treated earlier, just because we went a little bit lower with the CT scan. We also found patients with asymptomatic pulmonary embolism,” he said.
Cerebrovascular Accident CVA - Cerebrovascular Accident Computed Tomography CT Ct Scan Thromboembolism Scan Cardiovascular Imaging Cardiac Imaging CV Imaging Atrial Fibrillation AF Afib A-Fib Afib Afib Atrial Fib Atrial Fibrillation (AF) Atrial Fibrillation (A-Fib) AF - Atrial Fibrillation Heart Ct Angiography Computed Tomography Angiography
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