Predictors of Recurrent Stroke in Patients with Ischemic Stroke: Comparison Study between Transesophageal Echocardiography and Cardiac CT

Lee, Kyeho; Hur, Jin; Hong, Sae Rom; Suh, Young Joo; Im, Dong Jin; Kim, Yun Jung; Hong, Yoo Jin; Lee, Hye Jeong; Kim, Young Jin; Lee, Hye Sun; Hong, Geu‐Ru; Choi, Byoung Wook

doi:10.1148/radiol.15142300

Cited by 20 publications

(23 citation statements)

References 27 publications

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“…Over the last decade, radiological findings have gained more interest in predicting recurrent stroke. For instance, several studies that were based on findings of transesophageal echocardiography or cardiac CT angiography have reported associations between certain aortic plaque characteristics and recurrent hemorrhagic or ischemic stroke [6][7][8]. However, most imaging studies investigated different study populations and used different definitions for outcome, which makes it difficult to extract generalizable conclusions.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

et al. 2018

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Background: Predictors of recurrent ischemic stroke are less well known in patients with a recent ischemic stroke than in patients with transient ischemic attack (TIA). We identified clinical and radiological factors for predicting recurrent ischemic stroke in patients with recent ischemic stroke. Methods: A systematic search in PubMed, Embase, Cochrane Library, and CINAHL was performed with the terms “ischemic stroke,” “predictors/determinants,” and “recurrence.” Quality assessment of the articles was performed and the level of evidence was graded for the articles included for the meta-analysis. Pooled risk ratios (RR) and heterogeneity (I²) were calculated using inverse variance random effects models. Results: Ten articles with high-quality results were identified for meta-analysis. Past medical history of stroke or TIA was a predictor of recurrent ischemic stroke (pooled RR 2.5, 95% CI 2.1–3.1). Small vessel strokes were associated with a lower risk of recurrence than large vessel strokes (pooled RR 0.3, 95% CI 0.1–0.7). Patients with stroke of an undetermined cause had a lower risk of recurrence than patients with large artery atherosclerosis (pooled RR 0.5, 95% CI 0.2–1.1). We found no studies using CT or ultrasound for the prediction of recurrent ischemic stroke. The following MRI findings were predictors of recurrent ischemic stroke: multiple lesions (pooled RR 1.7, 95% CI 1.5–2.0), multiple stage lesions (pooled RR 4.1, 95% CI 3.1–5.5), multiple territory lesions (pooled RR 2.9, 95% CI 2.0–4.2), chronic infarcts (pooled RR 1.5, 95% CI 1.2–1.9), and isolated cortical lesions (pooled RR 2.2, 95% CI 1.5–3.2). Conclusions: In patients with a recent ischemic stroke, a history of stroke or TIA and the subtype large artery atherosclerosis are associated with an increased risk of recurrent ischemic stroke. Predictors evaluated with MRI include multiple ischemic changes and isolated cortical lesions. Predictors of recurrent ischemic stroke concerning CT or ultrasound have not been published.

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Section: Introductionmentioning

confidence: 99%

Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

et al. 2018

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“…We identified 1530 publications in the initial search, of which 42 were selected for full-length review. Of these, 14 articles fulfilled the inclusion criteria and were included in the analyses [8,[15][16][17][18][19][20][21][22][23][24][25][26][27].…”

Section: Study Selectionmentioning

confidence: 99%

CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis

et al. 2020

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Background and purpose Cardiac thrombi are an important cause of embolic stroke. We studied the diagnostic yield and diagnostic accuracy of cardiac CT angiography (CTA) compared to echocardiography for detection of cardiac thrombi in ischemic stroke patients. Methods We performed a systematic review and meta-analysis of the literature on cardiac CTA versus echocardiography for detection of cardiac thrombi in ischemic stroke patients. We included studies (N ≥ 20) in which both cardiac CTA (index test) and echocardiography (reference test) were performed and data on cardiac thrombi were reported. Results were stratified for type of echocardiography: transesophageal (TEE) vs transthoracic (TTE). Results Out of 1530 studies, 14 were included (all single center cohort studies), with data on 1568 patients. Mean age varied between 52 and 69 years per study and 66% were men. Reported time intervals ranged from 0 to 21 days between stroke and first test, and from 0 to 199 days between tests. In ten studies that compared CTA to TEE, CTA detected cardiac thrombi in 87/1385 (6.3%) patients versus 68/1385 (4.9%) on TEE (p < 0.001). In four studies comparing CTA to TTE, CTA detected thrombi in 23/183 (12.5%) patients versus 12/183 (6.6%) on TTE (p = 0.010). Pooled sensitivity and specificity of CTA versus TEE were 86.0% (95% CI 65.6-95.2) and 97.4% (95% CI 95.0-98.7), respectively. Conclusions CTA may be a promising alternative to echocardiography for detection of cardiac thrombi in patients with ischemic stroke, especially now that CTA is standard care for patient selection for endovascular treatment. However, studies were too heterogeneous and of insufficient methodological quality to draw firm conclusions. Large, prospective studies on this topic are warranted.

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“…Recently, we investigated cardiac CT findings predictive of recurrent stroke in 374 ischemic stroke patients (78). In our study, complex aortic plaques detected with TEE and cardiac CT were associated with an increased risk of stroke recurrence in patients with ischemic stroke.…”

Section: Review: Cardiac Ct Imaging For Ischemic Stroke Hur and Choimentioning

confidence: 88%

Cardiac CT Imaging for Ischemic Stroke: Current and Evolving Clinical Applications

Hur

Choi

2017

Radiology

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While the etiology of ischemic stroke is heterogeneous, approximately 20%-40% of all stroke cases result from cardiac or aortic origin. Transesophageal echocardiography (TEE) has become the reference standard modality for the detection of potential sources of cerebral embolism. Because of the advances in computed tomographic (CT) technology, cardiac CT can be used in the evaluation of potential cardioembolic sources. During the past decade, cardiac CT has been tested and compared with TEE for the diagnosis of cardioembolic sources. Many studies showed that cardiac CT is a very useful and powerful modality for the detection of cardioembolic sources, as well as for risk assessment in patients with stroke. Cardiac CT is a reliable alternative imaging modality to TEE for the evaluation of cardioembolic sources in patients with ischemic stroke, avoiding the discomfort and risks associated with TEE. In addition, cardiac CT can be used to simultaneously diagnose coronary artery disease in stroke patients. However, based on current guidelines, cardiac CT is currently not recommended for use in the initial evaluation of intracardiac structures or risk assessment in stroke patients. The aim of this review is to discuss the potential clinical applications of cardiac CT in an ischemic stroke population, focusing on the diagnosis of cardioembolic sources and cardiovascular risk assessment using cardiac CT. RSNA, 2017.

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Predictors of Recurrent Stroke in Patients with Ischemic Stroke: Comparison Study between Transesophageal Echocardiography and Cardiac CT

Abstract: Complex aortic plaque evaluated with cardiac CT and TEE was associated with an increased risk of stroke recurrence in patients with ischemic stroke.

Cited by 20 publications

References 27 publications

Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

CT angiography vs echocardiography for detection of cardiac thrombi in ischemic stroke: a systematic review and meta-analysis

Cardiac CT Imaging for Ischemic Stroke: Current and Evolving Clinical Applications

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