Background

Cardiac emboli are important causes of (recurrent) ischaemic stroke. Aorta atherosclerosis might also be associated with an increased risk of stroke recurrence. This study aimed to evaluate the yield and clinical implications of CT-angiography (CTA) of the heart and aorta in the diagnostic workup of transient ischaemic attack (TIA) or ischaemic stroke.

Methods

CTA of the heart and aortic arch was performed in TIA/ischaemic stroke patients, in addition to routine diagnostic workup. Occurrence of cardioembolic (CE) risk sources and complex aortic plaques were assessed. Implications of cardiac CTA for therapeutic management were evaluated

Results

Sixty-seven patients were included (TIA n = 33, ischaemic stroke n = 34) with a mean age of 68 years (range 51–89) and median NIHSS of 0 (interquartile range 0–2). CE risk sources were detected in 29 (43%) patients. An intracardiac thrombus was present in 2 patients (3%; TIA 0%; ischaemic stroke 6%). Medium/low-risk CE sources included mitral annular calcification (9%), aortic valve calcification (18%) and patent foramen ovale (18%). Complex aortic plaque was identified in 16 patients (24%). In two patients with an intracardiac thrombus, therapeutic management changed from antiplatelet to oral anticoagulation.

Conclusions

CTA of the heart and aorta has a high yield for detection of embolic risk sources in TIA/ischaemic stroke, with clinical consequences for 6% of ischaemic stroke patients. Implementation of CTA of the heart and aorta in the acute stroke setting seems valuable, but cost-effectiveness of this approach remains to be determined.

中文翻译：

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TIA和缺血性卒中的心脏和主动脉的CT血管造影：心脏栓塞的风险来源和临床意义

背景

心脏栓塞是缺血性中风（反复发作）的重要原因。主动脉粥样硬化也可能与中风复发的风险增加有关。这项研究旨在评估心脏和主动脉CT血管造影（CTA）在短暂性脑缺血发作（TIA）或缺血性中风的诊断检查中的产量及其临床意义。

方法

除常规诊断检查外，TIA /缺血性中风患者还进行了心脏和主动脉弓的CTA检查。评估心脏栓塞（CE）风险源和复杂的主动脉斑块的发生率。评估了心脏CTA对治疗管理的意义

结果

纳入了67例患者（TIA n = 33，缺血性卒中n = 34），平均年龄为68岁（范围51-89），中位NIHSS为0（四分位间距0-2）。在29名（43％）患者中发现了CE危险源。2例患者出现心内血栓（3％； TIA为0％；缺血性卒中为6％）。中/低​​危CE来源包括二尖瓣环钙化（9％），主动脉瓣钙化（18％）和卵圆孔未闭（18％）。在16例患者（24％）中发现了复杂的主动脉斑块。在两名患有心内血栓的患者中，治疗方法从抗血小板改为口服抗凝。

结论

心脏和主动脉的CTA检出TIA /缺血性中风的栓塞风险来源的产率很高，对6％的缺血性中风患者具有临床意义。在急性中风背景下实施心脏和主动脉的CTA似乎很有价值，但是这种方法的成本效益尚待确定。