When someone has a stroke, doctors race to find the cause. Sometimes the culprit is a blood clot hiding in the heart. A new analysis suggests that adding a quick heart CT scan to the usual stroke imaging could spot these clots more often than the standard ultrasound test.
The researchers pooled data from studies involving 3,919 people who had an acute ischemic stroke, meaning a stroke caused by a blocked blood vessel in the brain. They found that a heart CT scan detected a clot in about 6% of these patients. That's 243 out of 3,919 people.
Compared to transthoracic echocardiography, which is an ultrasound of the heart, the CT scan was much more likely to find a clot. In fact, the odds were 7.4 times higher. The extra scan time was short: about 6 minutes for a detailed ECG-gated scan, or just 13 seconds for a simpler one. The extra radiation was small, about 2.9 mSv.
People who had a heart clot were more likely to die within 90 days (33% vs. 15%) and had worse disability scores. However, the rate of another stroke was similar (5% vs. 4%), which was not a statistically significant difference. This is an observational analysis, so it can't prove that the clot caused the worse outcomes, but the link is concerning.
This is promising news, but it's not a final answer. The studies were observational, not randomized trials. Still, for stroke teams, adding a heart CT to the initial imaging could be a quick way to find hidden dangers and guide treatment.
