Cardiac CT Angiography in Acute Stroke Imaging (SCOPE-CT)

Stroke can occur when a blood clot travels to the brain and blocks blood flow. In some patients, these blood clots may originate in the heart. Standard emergency stroke imaging typically includes a CT scan of the head and CT angiography (CTA) of the head and neck, but does not routinely include imaging of the heart. This study will evaluate whether cardiac CT angiography (CTA) can be safely added to the standard acute stroke imaging workflow without delaying urgent stroke care. Participants with suspected acute ischemic stroke or high-risk transient ischemic attack (TIA) will undergo either prospective ECG-gated cardiac CTA or non-ECG-gated cardiac CTA during their acute stroke imaging examination. The primary goal of the study is to assess the feasibility of integrating cardiac CTA into routine stroke imaging by evaluating workflow impact, image quality, radiation exposure, contrast use, and protocol completion. Findings from this study may help improve the identification of cardiac sources of stroke and inform the design of future larger studies.

Inclusion Criteria: * Adult patients presenting with suspected acute ischemic stroke or TIA who undergo standard acute stroke CT/CTA imaging. * Age ≥18 years. * Suspected acute ischemic stroke or high-risk TIA. * Undergoing standard-of-care acute stroke CT/CTA. * Presentation within a clinically relevant acute stroke imaging window, ≤24 hours from last-known-well. * Able to undergo iodinated contrast-enhanced CTA Exclusion Criteria: * Known contraindication to iodinated contrast. * Severe renal impairment where additional contrast is deemed clinically inappropriate. * Hemodynamic instability precluding additional imaging. * Pregnancy. * Severe motion/agitation where imaging is not feasible. * Prior enrollment in the study. * The treating stroke/radiology team determines that additional cardiac CTA is not appropriate.