12 Potential cost-effectiveness of spectral photon-counting computed tomography (SPCCT) versus CT combined with CT angiography (CTA) in the identification and treatment of ischaemic stroke patients in the UK

Objective Transoesophageal echocardiography (TEE) is the gold standard for the detection of cardiac emboli sources in ischaemic stroke patients, but new computed tomography (CT) scanners are able to visualize the heart. This pilot study aimed to compare findings on TEE with combined cardiovascular scan and cerebral CT angiography in cryptogenic ischaemic stroke patients. Methods This pilot study enrolled patients with cryptogenic ischaemic stroke who underwent a combined cardiovascular and cerebral CT angiography scan and a TEE examination, which were interpreted in a blinded manner. Results Twelve patients with cryptogenic ischaemic stroke were included (mean age 56 years). Of these, 10 patients underwent both a combined cardiovascular and cerebral CT angiography and a TEE examination. All cardiovascular CT scans were readable at sinus rhythm. None of the simultaneous cerebral angiograms were compromised. Thrombi were not detected in any patients. Patent foramen ovale was visualized in five patients by TEE, while cardiovascular CT only identified three. Cardiovascular CT revealed in addition an X-ray negative pulmonary metastasis in one patient, aortic coarctation in another and significant coronary stenosis in four patients. Conclusion The sensitivity for detecting patent foramen ovale was considerably lower for cardiovascular CT than for TEE, however the cardiovascular CT revealed several other very important clinical findings.

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Outcome estimation based on multimodal computed tomography examination in acute ischaemic stroke patients treated with mechanical thrombectomy

Videosurgery and Other Miniinvasive Techniques ◽

10.5114/wiitm.2019.84761 ◽

2019 ◽

Vol 14 (4) ◽

pp. 560-566

Author(s):

Bartłomiej Łasocha ◽

Paweł Brzegowy ◽

Agnieszka Słowik ◽

Paweł Latacz ◽

Roman Pułyk ◽

...

Keyword(s):

Computed Tomography ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Mechanical Thrombectomy ◽

Stroke Patients

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Multimodal Computed Tomography in Acute Ischaemic Stroke

European Neurological Review ◽

10.17925/enr.2011.06.02.101 ◽

2011 ◽

Vol 6 (2) ◽

pp. 101

Author(s):

Sachin Rastogi ◽

David S Liebeskind ◽

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Keyword(s):

Computed Tomography ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Ct Perfusion ◽

Vascular Occlusion ◽

Vascular Pathology ◽

Stroke Patients ◽

Infarct Core ◽

Head Ct ◽

Ct Angiogram

Stroke is the third leading cause of death in the US, affecting 795,000 individuals annually. Currently, only a small percentage of acute stroke patients receive thrombolytic treatment. A significant limitation is the current use of strict time criteria in the decision to treat. As there are significant inter-individual variations in response to an acute vascular occlusion, the goal of modern imaging such as multimodal computed tomography (CT) is to rapidly identify acute ischaemic stroke patients and determine which patients are likely to benefit from treatment based on tissue perfusion status rather than time of presentation alone. Multimodal CT consists of a non-contrast head CT, CT angiogram (CTA) of the head and neck, and CT perfusion (CTP). The non-contrast head CT allows rapid triage of a patient with haemorrhagic versus ischaemic stroke. The CTA allows identification of the site of vascular pathology with similar quality to digital subtraction angiography. The CTP scan allows for determination of the infarct core and surrounding ischaemic penumbra, which remains at risk for infarction if perfusion is not restored. This allows the potential to prospectively treat only those patients likely to benefit from thrombolysis while protecting those patients unlikely to benefit from the risks associated with treatment.

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