Abstract Details

Title Cardiac CTA Findings in Patients with Acute Ischemic Stroke and Indications for Secondary Stroke Prevention

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 5-013

Objective Report CCTA findings from the diagnostic evaluation of AIS patients and review the evidence guiding secondary stroke prevention.

Background

Cardiac computed tomography angiography (CCTA) is increasingly utilized in the diagnostic evaluation of patients with acute ischemic stroke (AIS). Many findings, such as Watchman peridevice leak, device-related thrombus, left atrial appendage (LAA) thrombus while on DOAC, or complex aortic atheroma were previously uncommon. Optimal secondary stroke prevention strategies in this setting may be unclear.

Design/Methods CCTA was integrated into the standard-of-care diagnostic evaluation for AIS in our health system, in addition to routine transthoracic or transesophageal echocardiography. Patient demographics, stroke characteristics, and CCTA findings were analyzed descriptively, with a focus on clinically significant cardiac findings and associated evidence.

Results Among 241 patients with final diagnosis of AIS or TIA (median age was 74 [IQR: 65-81], female 41%, median NIHSS: 2 [IQR: 0-6], AIS 85.5%), 5.4% were found to have clinically significant cardiac findings on CCTA. These included peridevice leaks (3, 1.25%), LAA thrombus despite DOAC therapy (3, 1.25%), and complex aortic plaque with aortic thrombus (1, 0.5%). In several cases, these findings directly influenced secondary prevention, prompting individualized changes such as anticoagulant adjustments or cardiology follow up for device revision, despite the lack of standardized evidence.

Conclusions Embolic sources of stroke identified with Cardiac CTA often lack high-level evidence to inform optimal secondary stroke prevention. As Cardiac CTA use increases, standardized registries and multidisciplinary clinical trials could address these practice gaps.

Authors/Disclosures
Marcus Milani PRESENTER	Mr. Milani has nothing to disclose.
Nitin Ramanujam Chakravarthula, MBBS (University of Minnesota)	Dr. Chakravarthula has nothing to disclose.
Kai Akimoto	Mr. Akimoto has nothing to disclose.
Saketh Annam, MBBS	Dr. Annam has nothing to disclose.
Megan Tessmer, RN	Mrs. Tessmer has nothing to disclose.
Abbey Staugaitis	Abbey Staugaitis has nothing to disclose.
Jeremy Markowitz	Dr. Markowitz has nothing to disclose.
Rajat Kalra, MBChB, MS	The institution of Dr. Kalra has received research support from American Heart Association. The institution of Dr. Kalra has received research support from National Heart, Lung, and Blood Institute/NIH.
Christopher Streib, MD (Department of Neurology)	Dr. Streib has nothing to disclose.

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