Up to one-third of ischaemic strokes are caused by cardioembolism, which can result from atrial fibrillation (AF) or structural abnormalities.1 Establishing cardioembolic stroke aetiology is essential for secondary prevention, but cardiac thrombi may dissolve <2 hours after intravenous thrombolytic therapy (IVT).2 CT angiography (CTA) from aortic arch to intracranial vessels is necessary for patient selection for endovascular treatment (EVT) in most centres. We investigated the diagnostic yield and image quality of extending the non-ECG-gated CTA to include the heart for detection of structural cardio-aortic sources of embolism in the acute phase of ischaemic stroke, defined as within the time window for reperfusion therapy (IVT/EVT). We performed a single-centre, retrospective analysis of consecutive patients with acute ischaemic stroke with suspected large vessel occlusion (LVO) eligible for EVT who presented to the emergency department of Maastricht University Medical Center between March 2016 and April 2017. Patients underwent a non-contrast CT of the brain. Subsequently, patients with suspected LVO eligible for EVT underwent CT perfusion of the brain, and non-ECG-gated CTA from the heart to the intracranial arteries in the acute phase, as part of standard care. Patients <4.5 hours of onset of stroke without contraindications received IVT, directly after non-contrast CT and before CTA. Patients <6 hours of stroke onset with a National Institutes of Health Stroke Scale score ≥2 and/or disabling neurological deficit were eligible for EVT if LVO was identified …

中文翻译：

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非门控心脏CT血管造影用于检测缺血性卒中急性期的主动脉栓塞来源。

高达三分之一的缺血性中风是由心房栓塞（AF）或结构异常引起的心源性栓塞所致。1建立心源性中风病因对于二级预防至关重要，但是在静脉溶栓治疗后2小时内，心脏血栓可能会溶解（ IVT）.2在大多数中心，从主动脉弓到颅内血管的CT血管造影（CTA）对于患者进行血管内治疗（EVT）的选择是必要的。我们调查了将非ECG门控CTA扩展到包括心脏以检测缺血性卒中急性期栓塞的结构性主动脉血源的诊断率和图像质量，定义为再灌注治疗（IVT）的时间范围内/ EVT）。我们执行了一个单中心 对2016年3月至2017年4月在马斯特里赫特大学医学中心急诊室就诊的连续性急性缺血性卒中合并疑似大血管闭塞（LVO）的患者进行回顾性分析。患者接受了脑部CT扫描。随后，作为标准护理的一部分，在急性期，怀疑患有LVO并符合EVT要求的患者接受了脑部CT灌注以及从心脏到颅内动脉的非ECG门控CTA。发病时间<4.5小时且无禁忌症的患者在无造影剂后和CTA之前直接接受IVT。如果卒中发作时间少于6小时且美国国立卫生研究院卒中量表评分≥2和/或神经系统功能障碍，则可以确定是否患有LVO并获得EVT…