Moderated Poster Australian and New Zealand Stroke Organisation Conference 2025

ECG-Gated cardiac computed tomography in hyperacute stroke. (123317)

Rahul Pradhan 1 , Duncan Maddox 1 , Harry Olufson 1
  1. Princess Alexandra Hospital, Woolloongabba, QLD, Australia

Background/Aims

Current hyperacute stroke work-up at The Princess Alexandra Hospital (PAH) for majority of cases includes a computed tomography (CT) 'stroke series'. This include a non-contrast CT brain, angiogram from aorta to circle of Willis, and a CT perfusion scan. This allows for appropriate hyperacute stroke management, such as thrombolysis and endovascular clot retrieval. The utility of cardiac CT in addition to brain imaging has been studied and found to provide an aetiology for the stroke at presentation at a higher rate than standard work up with an echocardiogram of the heart. A proof-of-concept quality improvement trial at the PAH aims to demonstrate the viability, utility, and impact of adding a limited ECG-gated cardiac CT. 

Methods

Patients triaged as "Code Stroke" during business hours were considered for a ECG-gated cardiac CT by the Stroke Team. Data was collected which included key time points, including, but not limited to: time of arrival to CT scanner, time of first slice, and time of final slice.  

Results

At n=6, the average time from first slice to last slice was 13 minutes. There were technical issues in some cases with acquiring the scan. A left atrial thrombus was identified and anticoagulation was started in 1 case.  

Conclusion

There remain technical challenges with acquiring an ECG-gated cardiac CT. Impact on management has been demonstrated. More data collection is required to determine the viability and impact on stroke management from the use of ECG-gated cardiac CT as part of hyperacute stroke workup. 

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