Can a CT help to predict recurrent stroke?

The authors were interested in whether a CT was effective at identifying causes of cardioembolism, which is directly linked with stroke recurrence. They concluded that patients with larger and more complex aortic plaques were at a higher risk of recurrent stroke. They also concluded that CT was as effective as other invasive procedures in identifying those cases.

Many strokes are caused by cardiogenic (relating to the heart) embolism. This is a blood clot formed in the heart that results in a lack of blood supply to the brain. It is therefore important that clinicians are able to identify stroke patients at a high risk of cardiogenic embolism to prevent recurrent stroke. One method to check for possible causes of cardiogenic embolism is called transesophageal echocardiography (TEE). While TEE is accurate at identifying cardiac sources of embolism, it is an invasive procedure. In addition, it requires highly skilled professionals to interpret the results. Computed tomography (CT) scan is a more straight forward method that can detect sources of cardiogenic embolism. The predictive power of CT for recurrent stroke has not been investigated.

This study aimed to determine predictive factors for recurring stroke. In addition, the authors aimed to determine whether CT is as effective as TEE in detecting sources of cardiogenic embolism in stroke patients, thus predicting patients at higher risk of recurrent stroke.

The study included 374 stroke patients who underwent both TEE and CT to evaluate cardiogenic or aortogenic (relating to the aorta) embolism.

TEE demonstrated 436 abnormalities from all patients compared to 405 with CT. Both methods recognised 6 blood clots, 1 cardic tumor and 3 valvular vegetations (lesions on the heart valves). CT identified 275 aortic plaques (deposits on the aorta), 98 of which were complex (more than 4 mm thick). TEE recognised 251 plaques, 80 of which were complex.

After an average follow up of 433 days there were 28 recurrent strokes. Recurrent strokes were associated with patients with complex aortic plaques. There was no significant difference in the predictive power of TEE or CT scan.

The authors concluded that plaque size and complexity was a predictive factor for recurring stroke. They also concluded that CT is as effective as TEE at detecting aortic plaques.