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Minerva Cardiology and Angiology 2021 Mar 11

DOI: 10.23736/S2724-5683.21.05547-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Cardiovascular thrombotic complications in acute ischemic stroke assessed by chest spectral computed tomography during COVID-19

Gaston A. RODRIGUEZ-GRANILLO 1, 2 , Juan J. CIRIO 3, Celina CIARDI 3, Maria L. CABALLERO 3, Pablo DILUCA 4, Ricardo CASTRILLON 4, Marcos CERON 1, Esteban SCRIVANO 5, Pedro LYLYK 5

1 Department of Cardiovascular Imaging, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina; 2 Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Argentina; 3 Stroke Unit, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina; 4 Department of Radiology, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina; 5 Department of Interventional Radiology, Instituto Medico ENERI, Clinica La Sagrada Familia, Buenos Aires, Argentina


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During the pandemic context, diagnostic algorithms had to be adapted considering the decimated medical personnel, local technical resources, and the likelihood of contamination. Given the higher probability of thrombotic complications related to COVID-19 and the availability of a dual-layer spectral computed tomography (CT) scanner, we have recently adopted the use of low-dose, non-gated, chest CT scans performed five minutes after contrast administration among patients admitted with acute ischemic stroke (AIS) undergoing cerebrovascular CT angiography. Dual-layer spectral CT comprises a single X-ray source and two-layer detector with different photon-absorption capabilities. In addition to conventional images, the two distinct energy datasets obtained enable multiparametric spectral analysis without need to change the original scanning protocol. The two spectral features that emerge as most useful for patients with AIS are virtual monoenergetic imaging and iodine-based results. Aside from the evaluation of lung parenchyma, this novel strategy enables ruling out cardioembolic sources and simultaneously providing evidence of pulmonary and myocardial injury in a single session and immediately after CT cerebrovascular angiography. Furthermore, it involves a noninvasive, seemingly accurate, unsophisticated, safer (very low radiation dose and no contrast administration), and cheaper tool for ruling out cardioembolic sources compared to transesophageal echocardiogram and cardiac CT. Accordingly, we sought to standardize the technical aspects and overview the usefulness of delayed-phase, lowdose chest spectral CT in patients admitted with AIS.


KEY WORDS: Myocardial infarction; Thrombosis; Heart atria; Tomography

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