Cardiac Computed Tomographic Angiography for Detection of Cardiac Sources of Embolism in Stroke Patients

Hur, Jin; Kim, Young Jin; Lee, Hye Jeong; Ha, Jong Won; Heo, Ji Hoe; Choi, Eui Young; Shim, Chi Young; Kim, Tae Hoon; Nam, Ji Eun; Choe, Kyu Ok; Choi, Byoung Wook

doi:10.1161/strokeaha.108.537928

Cited by 68 publications

(69 citation statements)

References 27 publications

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“…CCTA could be useful modality for detecting high-risk cardiac sources of embolism in patients with stroke. 53,54 This technique can directly visualize the aortogenic and paradoxical embolic sources (Figure 3). A contrast agent jet from left atrium to right atrium toward the inferior vena cava with channel-like appearance of the interatrial septum on CT images confirms the presence of a PFO with high accuracy.…”

Section: Strokementioning

confidence: 99%

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Bang

Ovbiagele

Kim

2014

Stroke

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Section: Strokementioning

confidence: 99%

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Bang

Ovbiagele

Kim

2014

Stroke

View full text Add to dashboard Cite

“…A total of 19 studies [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] with 2955 patients (mean age, 61 years [SD, ±4]; men, 71%) with AF undergoing PVI/EC or patients with CVA being worked-up for cardioembolic source were included ( Table 1). The overall incidence for LA/LAA thrombi was 8.9% (SD, ±7).…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Detection of Left Atrial Appendage Thrombus by Cardiac Computed Tomography in Patients With Atrial Fibrillation

Romero

Husain

Kelesidis

et al. 2013

Circ: Cardiovascular Imaging

308

213

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Background-Transesophageal echocardiogram (TEE) is considered the gold standard modality in detecting left atrial/ LA appendage (LA/LAA) thrombi. However, this is a semi-invasive procedure with rare but potential life-threatening complications. Cardiac computed tomography has been proposed as an alternative method. The purpose of this metaanalysis was to evaluate the diagnostic accuracy of cardiac computed tomography assessing LA/LAA thrombi in comparison with TEE. Methods and Results-A systematic review of Medline, Cochrane, and Embase to look for clinical trials assessing detection of LA/LAA thrombi by cardiac computed tomography when compared with TEE in patients with a history of atrial fibrillation before electric cardioversion/pulmonary vein isolation or after cardioembolic cerebrovascular accident was performed using standard approach and bivariate analysis. Nineteen studies with 2955 patients (men, 71%; mean age, 61±4 years) fulfilled the inclusion criteria. Most studies (85%, 16 studies) used 64-slide multidetector computed tomography and 15 studies (79%) were electrocardiographic-gated. The incidence of LA/LAA thrombi was 8.9% (SD, ±7). The mean sensitivity and specificity were 96% and 92%, whereas the positive predictive value and negative predictive value were 41% and 99%, respectively. The diagnostic accuracy was 94%. In a subanalysis of studies in which delayed imaging was performed, the diagnostic accuracy significantly improved to a mean weighted sensitivity and specificity of 100% and 99%, respectively, whereas the positive predictive value and negative predictive value increased to 92% and 100%, respectively. The accuracy for this technique was 99%. Conclusions-Cardiac computed tomography, particularly when delayed imaging is performed, is a reliable alternative to TEE for the detection of LA/LAA thrombi/clot, avoiding the discomfort and risks associated with TEE.

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“…However, TEE has several limitations as a diagnostic tool and is not always feasible in acute stroke settings. 9,10 The recently introduced 64-multidetector-row CT (MDCT) is a powerful tool that enables rapid, noninvasive, and specific diagnosis of aortic pathology. 11,12 Recent studies show that MDCT is comparable to TEE in measuring plaque thickness, discovering ulceration, and evaluating plaque characteristics.…”

mentioning

confidence: 99%

Is Aortic Atherothrombotic Disease Detected Using Multidetector-Row CT Associated With an Increased Risk of Early Ischemic Lesion Recurrence After Acute Ischemic Stroke?

Kim

Jang

et al. 2012

Stroke

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Background and Purpose-Multidetector-row CT (MDCT) is emerging as a new tool for diagnosing aortic atherothrombotic disease (AAD). We elucidated whether MDCT-detected AAD is associated with an increased risk of early ischemic lesion recurrence on diffusion-weighted MRI after ischemic stroke. Methods-A consecutive series of patients with acute ischemic stroke confirmed using diffusion-weighted MRI who were hospitalized within 48 hours after symptom onset and underwent MDCT were identified in a prospective stroke registry database. AAD on MDCT was defined as the presence of plaque formation that was noncalcified and Ն4 mm thick, ulcerative, or soft and thrombosed (vulnerable) in the proximal aortic arch. Ischemic lesion recurrence on diffusionweighted MRI was defined as the occurrence of any new lesion separate from the index lesion on follow-up diffusion-weighted MRI performed within 14 days after symptom onset.

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Cardiac Computed Tomographic Angiography for Detection of Cardiac Sources of Embolism in Stroke Patients

Cited by 68 publications

References 27 publications

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Detection of Left Atrial Appendage Thrombus by Cardiac Computed Tomography in Patients With Atrial Fibrillation

Is Aortic Atherothrombotic Disease Detected Using Multidetector-Row CT Associated With an Increased Risk of Early Ischemic Lesion Recurrence After Acute Ischemic Stroke?

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