Cardiac CTA Findings in Patients with Acute Ischemic Stroke and Indications for Secondary Stroke Prevention
Marcus Milani1, Nitin Ramanujam Chakravarthula2, Kai Akimoto1, Saketh Annam2, Megan Tessmer2, Abbey Staugaitis2, Jeremy Markowitz2, Rajat Kalra2, Christopher Streib3
1University of Minnesota Medical School, 2University of Minnesota, 3Department of Neurology
Objective:
Report CCTA findings from the diagnostic evaluation of AIS patients and review the evidence guiding secondary stroke prevention.
Background:
Cardiac computed tomography angiography (CCTA) is increasingly utilized in the diagnostic evaluation of patients with acute ischemic stroke (AIS). Many findings, such as Watchman peridevice leak, device-related thrombus, left atrial appendage (LAA) thrombus while on DOAC, or complex aortic atheroma were previously uncommon. Optimal secondary stroke prevention strategies in this setting may be unclear.
Design/Methods:
CCTA was integrated into the standard-of-care diagnostic evaluation for AIS in our health system, in addition to routine transthoracic or transesophageal echocardiography. Patient demographics, stroke characteristics, and CCTA findings were analyzed descriptively, with a focus on clinically significant cardiac findings and associated evidence.
Results:
Among 241 patients with final diagnosis of AIS or TIA (median age was 74 [IQR: 65-81], female 41%, median NIHSS: 2 [IQR: 0-6], AIS 85.5%), 5.4% were found to have clinically significant cardiac findings on CCTA. These included peridevice leaks (3, 1.25%), LAA thrombus despite DOAC therapy (3, 1.25%), and complex aortic plaque with aortic thrombus (1, 0.5%). In several cases, these findings directly influenced secondary prevention, prompting individualized changes such as anticoagulant adjustments or cardiology follow up for device revision, despite the lack of standardized evidence.
Conclusions:
Embolic sources of stroke identified with Cardiac CTA often lack high-level evidence to inform optimal secondary stroke prevention. As Cardiac CTA use increases, standardized registries and multidisciplinary clinical trials could address these practice gaps.
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