Screening strategies for the diagnosis of coronary artery stenosis in patients with cerebral infarction using dual-source spiral CT

This study was to evaluate the benefit of the screening of coronary artery stenosis (CAS) using dual-source CT (DSCT) in patients with cerebral infarction caused by a Large Artery Atherosclerosis (LAA). From November 2007 to February 2008, 34 patients (25 males and 9 females; mean age, 62.4 ± 9.5 years) were enrolled. All of them had ischemic strokes of LAA type but with no cardiac symptoms. All patients underwent coronary CT angiography (CCTA) using DSCT. A significant coronary artery stenosis was defined as the one having more than 50% of luminal narrowing. We evaluated diagnostic accuracy for CAS in stroke patients of LAA with a receiver operating characteristics curve analysis. Of the 34 ischemic stroke patients, 18 (52.9%) had normal coronary arteries, 5 (14.7%) had insignificant CAS, and 11 (32.4%) had a significant CAS. The Agatston scores were more than 400 in 54.5% of the patients with a significant CAS, but less than 40 in 86.9% of the patients without it (p for trend = 0.001). For age, the optimal cut-off point for a diagnosis of CAS was 63, which had a sensitivity of 90.9%, a specificity of 69.6%, a positive predictive value of 58.8%, and a negative predictive value of 94.1%, respectively. For the Agatston score, the optimal cut-off was 40, which had 81.8%, 91.3%, 81.8%, and 91.3%, respectively. CCTA using DSCT appears to be a promising screening technique for CAS in patients with an ischemic stroke of LAA.