NDLI: Ischemic Stroke Patients with Active Malignancy or Extracardiac Shunts Are More Likely to Have a Right-to-Left Shunt Found by TCD Than Echocardiogram

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Translational Stroke Research : Volume 6, Issue 4, August 2015

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Translational Stroke Research : Volume 6, Issue 1, February 2015

Translational Stroke Research : Volume 5

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Translational Stroke Research : Volume 3

Translational Stroke Research : Volume 2

Translational Stroke Research : Volume 1

Ischemic Stroke Patients with Active Malignancy or Extracardiac Shunts Are More Likely to Have a Right-to-Left Shunt Found by TCD Than Echocardiogram

Content Provider	Springer Nature Link
Author	Havenon, Adam Moore, Anne Sultan Qurraie, Ali Majersik, Jennifer J. Stoddard, Greg Tirschwell, David
Copyright Year	2015
Abstract	Although the association between patent foramen ovale and ischemic stroke is controversial, the evaluation for a right-to-left shunt remains part of the standard workup for cryptogenic stroke. Transthoracic and transesophageal echocardiogram (TTE and TEE) are the screening test and gold standard to evaluate for right-to-left shunt, respectively. Studies comparing TTE or TEE to transcranial Doppler (TCD) have shown that 15–25 % of patients test positive for right-to-left shunt on TCD but are negative on TTE or TEE. We sought to further explore this phenomenon in patients with recent ischemic stroke. Between 2011 and 2013, 109 ischemic stroke patients had both a TCD and TTE or TEE bubble study. We abstracted 12 comorbid medical conditions and stroke subtype according to the TOAST classification. The majority of TCD and TTE or TEE showed agreement on right-to-left shunt status (80/109, 73 %). Two percent (2/109) of patients were negative on TCD and positive on TTE or TEE, while 25 % (27/109) had a positive TCD and negative TTE or TEE (TCD+Echo−). The TCD+Echo− patients were more likely to have active malignancy and the delayed arrival of contrast bubbles than the remainder of the cohort (15 vs. 2 %, p = 0.032; 51 vs. 18 %, p = 0.001). Our results confirm previous reports that TCD is superior to echocardiography in the detection of right-to-left shunt. The TCD+Echo− patients were more likely to have active malignancy and findings suggestive of an extracardiac shunt. These results could lead to more comprehensive evaluation for occult malignancy or a pulmonary arteriovenous malformation, both potentially treatable etiologies of ischemic stroke.
Starting Page	361
Ending Page	364
Page Count	4
File Format	PDF
ISSN	18684483
Journal	Translational Stroke Research
Volume Number	6
Issue Number	5
e-ISSN	1868601X
Language	English
Publisher	Springer US
Publisher Date	2015-07-25
Publisher Place	New York
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Right-to-left shunt PFO TCD Echocardiogram Cryptogenic stroke Neurosciences Neurology Cardiology Neurosurgery Vascular Surgery
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine Neuroscience Neurology (clinical)

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Ischemic Stroke Patients with Active Malignancy or Extracardiac Shunts Are More Likely to Have a Right-to-Left Shunt Found by TCD Than Echocardiogram

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Ischemic Stroke Patients with Active Malignancy or Extracardiac Shunts Are More Likely to Have a Right-to-Left Shunt Found by TCD Than Echocardiogram