Ischemic Stroke: The Role of Cardiac CT

Feasibility of the Big 5—Jena eCS Protocol

“…There are already studies comparing echocardiography and cardiac CT for cardiovascular cause finding in stroke patients, but not in the context of acute stroke [ 1 , 4 , 8 , 10 , 11 , 16 , 18 , 20 ]. We have developed a CT protocol for this purpose, and our initial experience with it has shown that such an approach is possible: the resulting imaging is of sufficient quality, acquisition times are not significantly longer than usual, the incrementation of radiation exposure is minimal, and the contrast medium application was slightly higher compared to the most common protocols.…”

“…Regarding the DLP findings, technical advances regarding CT acquisition images, including the iterative reconstruction, have considerably reduced the radiation exposure [ 3 , 4 , 21 ]. The extended cardio-stroke protocol leads to slightly higher radiation exposure than the usual CT protocols [ 22 – 25 ]; however, due to the equivalence of CT and TEE described in the literature regarding thrombus detection in patients after a stroke [ 5 , 15 , 17 ] and the additional possibility of evaluation of the aortic arch, the Big 5—Jena eCS protocol has been used as clinical standard at our radiology institute in the initial assessment of patients with acute stroke and suspicion of an ischemic etiology.…”

“…Compared to the echocardiography, the CT offers a superior anatomical visualization of the heart structures, allowing the evaluation of LAA and LA enlargement. Noteworthy, circulatory stasis, which is often detected before an LAA thrombus manifests, and LAA/LA enlargement are considered markers of embolism and predictors for stroke recurrence, even independent of atrial fibrillation [ 4 , 28 , 29 ].…”

“…Irrespective of the abovementioned limitations, the cardiac imaging included in our extended cardio-stroke protocol also allows the simultaneous evaluation of atherosclerotic disease as another embolism substrate [ 3 , 4 , 34 , 35 ], which could have important therapeutic implications in embolic stroke associated with atrial fibrillation [ 36 – 38 ]. The non-invasive character of CT combined with its reproducibility and the other advantages mentioned above highlight this technique as a reliable option in the assessment of acute stroke patients in the ED [ 8 , 25 ].…”

“…Stroke is one of the most common diagnoses seen in the emergency department and contributes to significant morbidity and mortality in the adult population [ 1 – 4 ]. A substantial number of stroke patients are often affected by underlying heart conditions leading to an ischemic event [ 4 , 5 ]. About 80–85% of strokes are ischemic events caused by a cerebral artery’s acute occlusion [ 6 – 8 ].…”