TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND CAROTID ULTRASOUND IN PATIENTS WITH CEREBRAL-ISCHEMIA - PREVALENCE OF FINDINGS AND RECURRENT STROKE RISK

Objectives. This study was conducted to determine the yield of transes ophageal echocardiographic findings in a consecutive series of patient s with stroke and transient ischemic attack, with and without carotid stenosis, and to estimate the recurrent stroke risk associated with sp ecific echocardiographic findings. Background. Transesophageal echocar diography has a high yield for identification of potential sources of cardiac embolism in patients with cerebral ischemia; however, the clin ical significance of the most commonly detected abnormalities is uncer tain. Methods. We evaluated 145 consecutively admitted patients with s troke or transient ischemic attack with bath transesophageal echocardi ography and carotid ultrasound. Patients were followed up prospectivel y for a mean duration of 18 months to document the rate of recurrent c erebral ischemia. Results. Transesophageal echocardiography detected a t least one potential cardiac source of embolism in 45% of the patient s. Atrial septal aneurysm and interatrial shunt were detected more fre quently in patients who did not have a significant carotid stenosis th at could account for their ischemic event. During follow-up, a higher rate of recurrent stroke or transient ischemic attack occurred in pati ents with positive transesophageal echocardiographic findings, particu larly atrial septal aneurysm, interatrial shunt and left atrial thromb us, Conclusions. These data support recent studies that suggest that a trial septal aneurysm and interatrial shunts may be a significant sour ce of cardioembolic stroke. Further studies are needed to clarify the optimal management of patients with these abnormalities.