Background/Aims
Computed tomography (CT) stroke protocol imaging with non-contrast, perfusion and angiography allows for acute assessment of patients with stroke symptoms. Extension of the protocol to include non-cardiac gated left atrial appendage (LAA) imaging has the potential to identify cardiac thrombus acutely. This has the potential to determine aetiology and guide management.
Methods
This study was a pilot of all patients in our centre undergoing acute CT stroke protocol imaging with the addition of non-cardiac gated LAA imaging.
Results
Twenty-two patients had LAA scans (8 (36%) women, mean age [95% CI] 65.1 [4.8] years, median NIHSS 14). Two (9%) patients were found to have left atrial appendage thrombus which led to a change in acute management. One patient had known hypertrophic obstructive cardiomyopathy and atrial fibrillation on dabigatran. This was changed to warfarin as a result of his LAA imaging. The other patient had no known cardiac history and was commenced on an anticoagulant instead of an antiplatelet for stroke prevention.
Conclusions
Non-cardiac gated LAA imaging added to standard acute CT stroke protocol imaging is a simple and inexpensive method of determining the presence of left atrial appendage thrombus at presentation. Further definitive studies of this technique are warranted.