Letter to the Editor: Practicability and Diagnostic Yield of One-Stop Stroke CT with Delayed-Phase Cardiac CT in Detecting Major Cardioembolic Sources of Acute Ischemic Stroke

2021 ◽  
Author(s):  
Leonard L. L. Yeo ◽  
Ching-Hui Sia ◽  
Aloysius S. T. Leow ◽  
Benjamin Yong Qiang Tan
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cardiac Ct ◽  
Diagnostic Yield ◽  
Letter To The Editor ◽  
One Stop ◽  
Delayed Phase

scholarly journals Practicability and Diagnostic Yield of One-Stop Stroke CT with Delayed-Phase Cardiac CT in Detecting Major Cardioembolic Sources of Acute Ischemic Stroke

2021 ◽  
Author(s):  
Friederike Austein ◽  
Matthias Eden ◽  
Jakob Engel ◽  
Annett Lebenatus ◽  
Naomi Larsen ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Early Stage ◽  
Recurrent Stroke ◽  
Cardiac Computed Tomography ◽  
Standard Of Care ◽  
Routine Work ◽  
One Stop ◽  
Work Up ◽  
Delayed Phase ◽  
Multimodal Ct

Abstract Purpose Recurrent stroke is considered to increase the incidence of severe disability and death. For correct risk assessment and patient management it is essential to identify the origin of stroke at an early stage. Transthoracic echocardiography (TTE) is the initial standard of care for evaluating patients in whom a cardioembolic source of stroke (CES) is suspected but its diagnostic capability is limited. Transesophageal echocardiography (TEE) is considered as gold standard; however, this approach is time consuming, semi-invasive and not always feasible. We hypothesized that adding a delayed-phase cardiac computed tomography (cCT) to initial multimodal CT might represent a valid alternative to routine clinical echocardiographic work-up. Material and Methods Patients with suspected acute cardioembolic stroke verified by initial multimodal CT and subsequently examined with cCT were included. The cCT was evaluated for presence of major CES and compared to routine clinical echocardiographic work-up. Results In all, 102 patients with suspected acute CES underwent cCT. Among them 60 patients underwent routine work-up with echocardiography (50 TTE and only 10 TEE). By cCT 10/60 (16.7%) major CES were detected but only 4 (6.7%) were identified by echocardiography. All CES observed by echocardiography were also detected by cCT. In 8 of 36 patients in whom echocardiography was not performed cCT also revealed a major CES. Conclusion These preliminary results show the potential diagnostic yield of delayed-phase cCT to detect major CES and therefore could accelerate decision-making to prevent recurrence stroke. To confirm these results larger studies with TEE as the reference standard and also compared to TTE would be necessary.

A “one-stop-shop” 4D CTA protocol using 320-row CT for advanced imaging in acute ischemic stroke: a technical note

2019 ◽  
Vol 29 (9) ◽  
pp. 4930-4936 ◽  
Author(s):  
Julien Ognard ◽  
Brieg Dissaux ◽  
Karim Haioun ◽  
Michel Nonent ◽  
Jean-Christophe Gentric ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Technical Note ◽  
Advanced Imaging ◽  
One Stop

scholarly journals Prediction of Hemorrhagic Transformation and Functional Prognosis in Patients With Acute Ischemic Stroke Using One-stop CT Examination: A Study on the Plateau Region of China

2021 ◽  
Author(s):  
Meng Li ◽  
Huiying Hu ◽  
Weixia Li ◽  
Chengpin Bai ◽  
Xin Bai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diagnostic Value ◽  
Hemorrhagic Transformation ◽  
Imaging Data ◽  
Plateau Region ◽  
Ct Examination ◽  
Great Vessels ◽  
One Stop

Abstract There are few studies on the early hemorrhagic transformation of ischemic stroke in plateau area. This study aimed to analyze the value of one-stop CT in predicting HT and functional outcomes in patients with acute ischemic stroke (AIS) caused by occlusion of great vessels before treatment in the high plateau region. Data were obtained from patients who underwent non-enhanced CT (NCCT), CTP and CTA examination within 24 hours from October 2019 to December 2020. Follow-up CT/MRI was performed within one month to determine if HT occurred later. The clinical data, laboratory results and imaging data of patients with and without HT were compared. Of the 74 patients included, 32(43.3%) had HT during follow-up, and HT was more likely to occur in poor collateral circulation (p = 0.029). The values of MTT, Tmax, PS, rCBV, rMTT, rPS in HT group were higher than those in non-HT group (p < 0.05). The results showed that PS > 1.315 ml/100 g/min (AUC, 0.753, p = 0.001) and rCBV > 1.470(AUC, 0.764; p=0.001) had better diagnostic value for HT. One-stop CT examination was performed before treatment in patients with AIS. Quantitative perfusion parameters and multi-phase CTA were used to evaluate the prognosis of HT after recanalization of proximal great vessels.

Diagnostic yield of external loop recording in patients with acute ischemic stroke or TIA

2015 ◽  
Vol 262 (3) ◽  
pp. 682-688 ◽  
Author(s):  
Gerben J. J. Plas ◽  
Jorieke Bos ◽  
Bob Oude Velthuis ◽  
Marcoen F. Scholten ◽  
Heleen M. den Hertog ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diagnostic Yield ◽  
External Loop

Diagnostic Yield of Electroencephalography When Seizure Is Suspected in Acute Ischemic Stroke

2021 ◽  
pp. 194187442110212
Author(s):  
Mohanad AlGaeed ◽  
Manjot Grewal ◽  
Prarthana Hareesh ◽  
Soha Sadeghikhah ◽  
Hai Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diagnostic Yield ◽  
Care Center ◽  
Tertiary Care ◽  
Secondary Analysis ◽  
Retrospective Chart Review ◽  
The United States ◽  
Primary Diagnosis ◽  
Eeg Monitoring

Introduction: Seizures are a common complication after an ischemic stroke. Electroencephalography can assist with the diagnosis of seizures however, the diagnostic yield of its use when seizure is suspected in the setting of acute ischemic stroke is unknown. We aim to evaluate the yield and cost of EEG in the acute ischemic stroke setting. Methods: We conducted a retrospective chart review of patients admitted to a single academic tertiary care center in the United States between September 1, 2015 to November 30, 2019 with a primary diagnosis of acute ischemic stroke and who were monitored on electroencephalography (EEG) for suspected seizures (total number of 70 patients). The primary outcome was how often EEG monitoring changed clinical management defined as starting, stopping, or changing the dose of an anti-epileptic drug. Secondary analysis was estimating the cost of EEG monitoring per change in management. Results: We identified 126 patients admitted with acute ischemic stroke who underwent EEG of which 70 met all inclusion and exclusion criteria. EEG monitoring resulted in a change in management in 22 patients (31%). Predictors associated with EEG monitoring resulting in a change in management were admission to the ICU, pre-existing atrial fibrillation, and symptomatic hemorrhagic transformation. Estimated cost of EEG per change in management was $1374.96 USD. Conclusion: EEG monitoring resulted in a changed management in nearly one-third of patients admitted with acute ischemic stroke suspected of having seizures.

Abstract WP382: Cardiac Troponin Assessment in Acute Ischemic Stroke Patients Presenting Within 4.5 Hours From Last Known Well

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Yuyao Sun ◽  
Malgorzata M Miller ◽  
Nils Henninger
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Time Window ◽  
Diagnostic Yield ◽  
Heart Association ◽  
Coronary Syndrome ◽  
Cardiac Symptoms ◽  
History Of

Introduction: American Heart Association guidelines recommend obtaining baseline troponin in all acute ischemic stroke (AIS) patients to detect an acute coronary syndrome (ACS). Yet, data regarding the prevalence and diagnostic yield of troponin elevation in patients presenting within the time window for thrombolysis is limited. We sought to determine the diagnostic yield of cTnI in detecting ACS when assessed before or after 4.5h from last known well (LKW). Methods: We retrospectively analyzed 526 consecutive patients admitted for AIS or transient ischemic attack, who presented within 4.5h and had cardiac troponin I (cTnI) obtained within 48h from LKW. Results: The median time from LKW to cTnI measurement was 3.8h (IQR 1.5h-7.9h). 58% patients (n=306) had cTnI obtained ≤ 4.5h from LKW. After adjustment, factors independently relating to an elevated cTnI were the time to cTnI assessment (p<0.001), patient age (p=0.012), history of congestive heart failure (p<0.001), and a history of stroke/TIA (p=0.049). Patients who had a cTnI obtained within 4.5 hours from LKW, had significantly more often a normal (≤0.04 ng/mL) than elevated (>0.04 ng/mL) cTnI levels (61.9% vs. 44.7%; p=0.001). The sensitivity, specificity, and overall accuracy of an elevated cTnI assessed within 48h from LKW for ACS was 63.6%, 80.2%, and 79.5%, respectively. After stratification by the time to cTnI assessment within 4.5 h versus beyond 4.5h, the sensitivity of an elevated cTnI for ACS was markedly reduced to 42.9% whereas the specificity remained high at 84%. The optimal threshold to assess cTnI for detecting an ACS was 320 min in all included patients (sensitivity = 0.54, specificity = 0.67, Youden’s J = 0.203) and 340 minutes in patients with ACS (sensitivity 0.79, specificity 0.88, Youden’s J 0.661). Conclusions: Among patients presenting within the time window for rtPA treatment, the sensitivity of cTnI obtained within 4.5 hours from LKW to detect ACS is low. Our data suggests that cTnI routine assessment of cTnI in AIS subjects without cardiac symptoms should not be done within the first 6 hours from LKW.

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