Including Heart in Imaging May Improve Stroke Outcomes
A new study has demonstrated that including the heart in imaging conducted within the first minutes of a patient’s arrival to the hospital with acute stroke significantly improves the ability to determine the underlying cause of the stroke.
Not only does this improve treatment in the moment, but the information gathered can also be used to inform a treatment plan for preventing future strokes. Findings were published in The Lancet Neurology.
“Identifying where the clot came from is essential because it determines the safest and most effective treatment,” said Luciano Sposato, MD, MBA, FRCPC, Scientist at London Health Sciences Centre Research Institute (LHSCRI), Head of the Southwestern Ontario Regional Stroke Centre at London Health Sciences Centre (LHSC), and Professor of Neurology at Schulich Medicine & Dentistry. “If the clot originated in the heart, we typically use blood thinners to prevent future strokes.”
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In this single-center, prospective, randomized, open-label, blinded end point trial, researchers investigated whether strokes with undetermined causes could be identified using computed tomography (CT) scans that encompassed images of the heart and aorta. Patients were randomly assigned in a 1:1 ratio to receive standard CT angiography or extended CT angiography. The primary outcome was detection of a cardioaortic thrombus and the primary safety outcome was time to CT angiography completion.
Overall, the trial included 465 (226 in extended CT angiography and 239 in standard CT angiography) patients admitted to the LHSC University Hospital who were treated for ischemic stroke or transient ischemic attack. Cardioaortic thrombus was found in 20 patients of the extended CT angiography group and 4 patients in the standard CT angiography group (odds ratio 5.70; 95% CI, 1.92-16.96; p=0.002). Additionally, the extended CT scan did not cause delays in an emergency setting.
“Performing extended CT angiography during acute code strokes is feasible and results in increased cardioaortic thrombi detection without causing delays in CT angiography completion,” authors concluded. “Future studies should assess whether extended CT angiography can reduce recurrent stroke risk by prompting early anticoagulation after thrombus detection.”
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