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Carotid angio-CT and two-phases heart CT-scan can decrease the rate of undetermined cerebral ischemic stroke

Aims: Evaluate the interest of a two-phases heart CT-scan in addition to brain and carotid angio-CT to reduce the rate of undetermined cause of ischemic stroke.

Methods: A prospective study was conducted between March 2015 and June 2018 including patients with a suspected cerebral stroke undergone cerebral CT. A specific CT protocol was performed including two-phase cardiac computed tomography (arterial and late phase). Causes of cerebral stroke were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system, from imaging data and clinical records.

Results: One hundred and thirty -two patients were included (69 men and 63 women, mean age 75,7 +/- 12,9). There were on the computed tomography scan 34,09 % (n=45) of SEC and 20,45 % (n=27) thrombus and 39,39 % (n=52) thrombus and/or SEC. Cardio-embolism was the most common etiology with 59,85% (n=79). Then, large artery atherosclerosis represent 15,91% (n=21), mixed origin 4,55% (n=6), small vessels occlusion : 2,27 % (n=3) and others determined causes : 3,03% (n=4). A total of 14,39% (n=19) were classified as undetermined etiology, which is the lowest rate among the data of literature.

Conclusion: Angio-CT with two-phases heart CT-scan can reduce the undetermined cause rate in the etiological assessment of ischemic stroke by improving the detection of cardiac thrombi.