“Since most of our patients get a CTA during acute stroke, it made sense to check the heart for embolic sources.” There isn’t any time to give a beta-blocker, so “these were nongated” scans, Dr Yeo said during a presentation at the International Stroke Conference in Los Angeles in February.
If studies confirm that nongated heart CTAs provide useful information, “we will probably all be doing this in the future. Everybody does CTs for the head in acute stroke, so all you do is go down a little lower” without any more contrast. “Within an hour of somebody presenting, you know what they have,” said Dr Robert Hart, a neurology professor at McMaster University in Hamilton, Ontario, and co-moderator of Dr Yeo’s presentation.
In most places, acute ischemic stroke patients only receive an ECG. Transesophageal echocardiography is also good for assessing the heart, but is often performed later. It “excels at detecting abnormalities with medium embolic risk,” such as patent foramen ovale and septal aneurysm. “However, for these medium-risk cardiac sources of embolism, the optimal choice of therapy is not clear. Unlike high-risk sources which require anticoagulation, TEE does not provide therapeutic gains in terms of clinical decision making,” Dr Yeo said.
Nongated cardiac CTAs during acute stroke, he added, also check chamber, valve, pericardial, and great vessel morphology, as well as abnormal chambers-vessel communications and “left ventricular aneurysms that can rupture with [tissue plasminogen activator], with catastrophic consequences.”
1. Yeo L, Ting E, Eide SE, et al. Non-gated cardiac CT angiograms for detection of embolic sources in acute ischemic stroke. Abstract presented at: International Stroke Conference; February 19, 2016; Los Angeles, CA. Abstract 208.