Nongated Cardiac Computed Tomographic Angiograms for Detection of Embolic Sources in Acute Ischemic Stroke

• DOI: 10.1161/strokeaha.117.016903
• Publication Date: 2017-04-07T02:20:37Z
• Authors: Leonard L.L. Yeo; Staffan Holmin; Tommy Andersson; Erik Lundström; Anil Gopinathan; Er Luen Lim; Benjamin S.H. Leong; Win Sen Kuan; Eric Ting; Benjamin Y.Q. Tan; Sterling Ellis Eide; Edgar L.K. Tay
• Keywords: Computed tomographic angiography; Stroke; Acute stroke

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