NCT05522244: DAYLIGHT

The Extended CTA for the Successful Screening of Cardioaortic Thrombus in Acute Ischemic Stroke and TIA (DAYLIGHT) Trial

Completed NA Last updated 1 April 2025

What this trial tests

NA trial testing extended CTA in Acute Ischemic Stroke in 830 participants. Completed in 27 November 2024.

Timeline

17 July 2023

Primary endpoint
25 May 2024

27 November 2024

Quick facts

Lead sponsor	London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's
Phase	NA
Status	Completed
Study type	INTERVENTIONAL
Allocation	randomized
Design	parallel
Masking	none
Primary purpose	prevention
Enrollment	830
Start date	17 July 2023
Primary completion	25 May 2024
Estimated completion	27 November 2024
Sites	1 location across Canada

Drugs / interventions tested

• extended CTA

Conditions studied

• Acute Ischemic Stroke — all drugs for Acute Ischemic Stroke →
• Transient Ischemic Attack — all drugs for Transient Ischemic Attack →
• Intracardiac Thrombus — all drugs for Intracardiac Thrombus →

Sponsor

London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's

Who can join

18 and older, any sex, with Acute Ischemic Stroke or Transient Ischemic Attack. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

Embolic strokes of undetermined source (ESUS) represent a subset of cryptogenic strokes that are suspected to have an occult embolic source. The risk of stroke recurrence in patients with ESUS varies between 1.9%/year and 19.0%/year depending on the prevalence of vascular risk factors. Part of the elevated recurrence rate is due to the inability to identify high-risk treatable causes such as cardiac thrombi as those found in the left atrial appendage (LAA), left atrium (LA), left ventricle (LV), valves, or aortic arch. The most frequently used diagnostic method in clinical practice to detect cardioaortic thrombi is transesophageal echocardiography (TEE). However, the relatively low availability, higher cost, and invasive nature of TEE limit its large-scale usability. In most stroke centers, patients presenting with an acute ischemic stroke or TIA undergo a tomography (CT) angiography (CTA) of the neck and intracranial vessels. This standard of care CTA (sCTA) classically includes the aortic arch, the higher portion of the ascending/descending aorta, and the rostral portion of the cardiac chambers, but does not involve the LAA, LV, or cardiac valves. A recent study performed among 300 patients with an acute ischemic stroke showed an overall LAA thrombus detection of 6.6% and 15% in patients with AF by extending the CTA 6 cm below the carina. This is an extraordinarily high prevalence of LAA compared to 0.5% to 4.8% of intracardiac thrombi identified on TEE in most previous studies. The major limitation of previous CTA and TEE studies is their observational design, so the differing prevalence of LAA thrombi could be explained by dissimilar population characteristics or selection bias. Based on the methodological limitation of prior studies and the promising role of extended CTAs (eCTA), a randomized controlled trial comparing eCTA + standard of care stroke workup vs. sCTA + standard of care stroke workup is needed.

Publications & conference data

1 peer-reviewed publication reference this trial (live from Europe PMC):

1. Extended CT angiography versus standard CT angiography for the detection of cardioaortic thrombus in patients with ischaemic stroke and transient ischaemic attack (DAYLIGHT): a prospective, randomised, open-label, blinded end-point trial.
   Sposato LA, Ayan D, Ahmed M, Fridman S, et al · · 2025 · cited 5× · PMID 40409313 · DOI 10.1016/s1474-4422(25)00111-5