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Cardiovascular FLASH CT versus Transesophageal Echocardiography in Cryptogenic Acute Stroke

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Cardiovascular FLASH CT versus Transesophageal Echocardiography in Cryptogenic Acute Stroke Ulriksen PS2 , Poulsen MB1 , Overgaard MS1 , Kristensen M2 , Nilsson B3 , Soja AMB3 ,Rasmussen RS5 , Binici Z4 , Kruuse CR1 , Overgaard K1 1Department of Neurology, Herlev Hospital, 2Department of Radiology, Herlev Hospital, 3Department of Cardiology, Hvidovre Hospital,4Department of Cardiology, Rigshospitalet, University of Copenhagen, Biotech Research and Innovation Centre Background Transesophageal echocardiography (TEE) is the gold standard for detection of cardio-embolic sources but is semi-invasive and uncomfortable. ECG-gated FLASH-CT (high-pitch spiral-CT) makes it possible to include a very low-dose heart-scan to the standard cerebrovascular angiogram protocol by starting ~10cm below the usual aortic arch – allowing a complete work-up of thromboembolic sources to stroke in one examination. Method Twelve cryptogenic acute stroke patients (mean age 56 ) were consecutively included at the department of neurology. Patients underwent a combined cardiovascular and cerebral CT-angiogram besides standard work-up: Thoracic X-ray, carotid ultrasound and a TEE. Results of the two approaches were interpreted blinded. Results All cardiovascular CT scans were readable. None of the simultaneous cerebral angiograms were compromised. No thrombi where detected. Patent oval foramen was visualized by TEE in five patients, while CT only visualized three. 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: ECG-gated combined cardiovascular and cerebral angiogram was feasible as a general screening for cardio-embolic sources in acute stroke patients. Patent oval foramen was detected less frequent with cardiovascular CT compared to TEE. However the rational cardiovascular CT-approach revealed several other very important clinical findings and might be faster, more cost-effective and comfortable for the patient compared to standard work-up.

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