Objective:

To assess the feasibility of cardiac CT angiography (CCTA) in routine ischemic stroke workup.

Background:

Echocardiography, the current gold standard for evaluating cardioembolic sources of acute ischemic stroke (AIS), is relatively low-yield, not readily available at all hospitals, and may delay treatment and disposition. CCTA offers superior visualization of cardiac structures, but is not a standard practice. We report the preliminary results of a pilot study assessing the feasibility of integrating CCTA into routine AIS and transient ischemic attack (TIA) evaluation.

Design/Methods:

In 2024, we incorporated CCTA as a standard of care diagnostic evaluation in ischemic stroke workup. CCTA was either integrated with CT angiograms of the head/neck utilizing a single contrast bolus or performed as a standalone study. We report the demographics, stroke characteristics, type of CCTA obtained, image quality, time taken, contrast dose, and radiation exposure using descriptive statistics.

Results:

Our study population consisted of 88 patients with the final diagnosis of AIS (70) and TIA (18). The median (IQR) age was 70 (65-80) and NIH Stroke Scale was 2.5 (0-9). 48.9% were female.  Standalone CCTA (70) was more common than integrated CCTA (18). 90% had good imaging quality. The addition of CCTA to a patients conventional CTA Head/Neck increased radiation exposure by an average of 4.56 mSv, increased scanning time by 1 minute 19 seconds, and did not have a marked impact on the amount of contrast administered 98 mL vs 96 mL.

Conclusions:

In our real-world pilot study, CCTA demonstrated feasibility and provided good quality images for routine AIS evaluation. This occurred at the cost of increased radiation and scanning time, but not contrast dose.