Transesophageal echocardiography and carotid ultrasound in patients with cerebral ischemia: prevalence of findings and recurrent stroke risk

Department of Internal Medicine (Cardiology), Virginia Mason Medical Center, Seattle, Washington.

OBJECTIVES. This study was conducted to determine the yield of transesophageal echocardiographic findings in a consecutive series of patients with stroke and transient ischemic attack, with and without carotid stenosis, and to estimate the recurrent stroke risk associated with specific echocardiographic findings. BACKGROUND. Transesophageal echocardiography has a high yield for identification of potential sources of cardiac embolism in patients with cerebral ischemia; however, the clinical significance of the most commonly detected abnormalities is uncertain. METHODS. We evaluated 145 consecutively admitted patients with stroke or transient ischemic attack with both transesophageal echocardiography and carotid ultrasound. Patients were followed up prospectively for a mean duration of 18 months to document the rate of recurrent cerebral ischemia. RESULTS. Transesophageal echocardiography detected at least one potential cardiac source of embolism in 45% of the patients. Atrial septal aneurysm and interatrial shunt were detected more frequently in patients who did not have a significant carotid stenosis that could account for their ischemic event. During follow-up, a higher rate of recurrent stroke or transient ischemic attack occurred in patients with positive transesophageal echocardiographic findings, particularly atrial septal aneurysm, interatrial shunt and left atrial thrombus. CONCLUSIONS. These data support recent studies that suggest that atrial septal aneurysm and interatrial shunts may be a significant source of cardioembolic stroke. Further studies are needed to clarify the optimal management of patients with these abnormalities.

This article has been cited by other articles:

				A Wahl, M Kunz, A Moschovitis, T Nageh, M Schwerzmann, C Seiler, H P Mattle, S Windecker, and B Meier Long-term results after fluoroscopy-guided closure of patent foramen ovale for secondary prevention of paradoxical embolism Heart, March 1, 2008; 94(3): 336 - 341. [Abstract] [Full Text] [PDF]

				M. R. Di Tullio, R. L. Sacco, R. R. Sciacca, Z. Jin, and S. Homma Patent Foramen Ovale and the Risk of Ischemic Stroke in a Multiethnic Population J. Am. Coll. Cardiol., February 20, 2007; 49(7): 797 - 802. [Abstract] [Full Text] [PDF]

				B. Meier Patent Foramen Ovale, Guilty But Only as a Gang Member and for a Lesser Crime J. Am. Coll. Cardiol., January 17, 2006; 47(2): 446 - 448. [Full Text] [PDF]

				S Sen, S Laowatana, J Lima, and S M Oppenheimer Risk factors for intracardiac thrombus in patients with recent ischaemic cerebrovascular events J. Neurol. Neurosurg. Psychiatry, October 1, 2004; 75(10): 1421 - 1425. [Abstract] [Full Text] [PDF]

				M. J Landzberg and P. Khairy Indications for the closure of patent foramen ovale Heart, February 1, 2004; 90(2): 219 - 224. [Full Text] [PDF]

				B. Meier and J. E. Lock Contemporary Management of Patent Foramen Ovale Circulation, January 7, 2003; 107(1): 5 - 9. [Full Text] [PDF]

				F. Martin, P. L. Sanchez, E. Doherty, P. J. Colon-Hernandez, G. Delgado, I. Inglessis, N. Scott, J. Hung, M. E. E. King, F. Buonanno, et al. Percutaneous Transcatheter Closure of Patent Foramen Ovale in Patients With Paradoxical Embolism Circulation, August 27, 2002; 106(9): 1121 - 1126. [Abstract] [Full Text] [PDF]

				M Strandberg, R J Marttila, H Helenius, and J Hartiala Transoesophageal echocardiography in selecting patients for anticoagulation after ischaemic stroke or transient ischaemic attack J. Neurol. Neurosurg. Psychiatry, July 1, 2002; 73(1): 29 - 33. [Abstract] [Full Text] [PDF]

				K Nedeltchev, M Arnold, A Wahl, M Sturzenegger, E E Vella, S Windecker, B Meier, and H P Mattle Outcome of patients with cryptogenic stroke and patent foramen ovale J. Neurol. Neurosurg. Psychiatry, March 1, 2002; 72(3): 347 - 350. [Abstract] [Full Text] [PDF]

				J. Hung, M. J. Landzberg, K. J. Jenkins, M. E. E. King, J. E. Lock, I. F. Palacios, and P. Lang Closure of patent foramen ovale for paradoxical emboli: intermediate-term risk of recurrent neurological events following transcatheter device placement J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1311 - 1316. [Abstract] [Full Text] [PDF]

				S. Windecker, A. Wahl, T. Chatterjee, A. Garachemani, F. R. Eberli, C. Seiler, and B. Meier Percutaneous Closure of Patent Foramen Ovale in Patients With Paradoxical Embolism : Long-Term Risk of Recurrent Thromboembolic Events Circulation, February 29, 2000; 101(8): 893 - 898. [Abstract] [Full Text] [PDF]

				J CHAMBERS Should percutaneous devices be used to close a patent foramen ovale after cerebral infarction or TIA? Heart, November 1, 1999; 82(5): 537 - 538. [Full Text]

				M. K. Kapral and F. L. Silver Preventive health care, 1999 update: 2. Echocardiography for the detection of a cardiac source of embolus in patients with stroke Can. Med. Assoc. J., October 1, 1999; 161(8): 989 - 996. [Abstract] [Full Text] [PDF]

				M. Ide, H. Ishida, and H. Kato Early Postoperative Stroke in a Patient with an Atrial Septal Aneurysm Anesth. Analg., August 1, 1999; 89(2): 300 - 300. [Full Text] [PDF]

				Y. Agmon, B. K. Khandheria, I. Meissner, F. Gentile, J. P. Whisnant, J. D. Sicks, W. M. O'Fallon, J. L. Covalt, D. O. Wiebers, and J. B. Seward Frequency of Atrial Septal Aneurysms in Patients With Cerebral Ischemic Events Circulation, April 20, 1999; 99(15): 1942 - 1944. [Abstract] [Full Text] [PDF]

				S. Homma, M. R. Di Tullio, R. L. Sacco, R. R. S. , C. Smith, and J. P. Mohr Surgical Closure of Patent Foramen Ovale in Cryptogenic Stroke Patients Stroke, December 1, 1997; 28(12): 2376 - 2381. [Abstract] [Full Text]

				D. W.J. Dippel and P. J. Koudstaal We Need Stronger Predictors of Major Vascular Events in Patients With a Recent Transient Ischemic Attack or Nondisabling Stroke Stroke, April 1, 1997; 28(4): 774 - 776. [Abstract] [Full Text]

				M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]

				J. Aksnes, H. L. Lindberg, and H. Ihlen Surgical Elimination of an Atrial Septal Aneurysm Causing Cerebral Embolism Ann. Thorac. Surg., October 1, 1996; 62(4): 1190 - 1192. [Abstract] [Full Text]

				G. Rauh, M. Fischereder, and F. A. Spengel Transesophageal Echocardiography in Patients With Focal Cerebral Ischemia of Unknown Cause Stroke, April 1, 1996; 27(4): 691 - 694. [Abstract] [Full Text]

				D. C. Tong and G. W. Albers Transcranial Doppler–Detected Microemboli in Patients With Acute Stroke Stroke, September 1, 1995; 26(9): 1588 - 1592. [Abstract] [Full Text]