TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN VARIOUS ISCHEMIC STROKE SUBTYPES

Transesophageal echocardiography (TEE) is more sensitive than transtho racic echocardiography (TTE) in detecting tile potential source of emb oli in cardioembolic strokes (CES). To establish the prevalence of a p otential cardiac source of embolism detectable on TEE and its relation ship to vascular risk factors, an unselected ischemic stroke populatio n was evaluated. Twenty-six age and sex-matched cases with normal card iological and neurological examinations as well as normal CT-scans, TT E and ECGs were included in the study as the control group. One hundre d and eight patients with cardioembolic stroke (53 patients), atheroth rombotic stroke (36 patients), and lacunar stroke (19 patients) were i nvestigated by TTE and TEE. Seven of the 26 (26.9%) controls had thora cic atherosclerotic plaques on TEE examinations. The prevalence of abn ormal TEE findings in patients was higher compared to the controls (p < 0.001). TEE revealed more specific findings in every etiological gro up when compared to TTE (74.0% vs 10.2%, p < 0.001). Atrial fibrillati on correlated with the abnormalities of TEE (p < 0.05) while other ris k factors did not. Left atrial spontaneous echo contrast was the most common finding on TEE of cases with cardioembolic stroke while atheros clerotic aortic plaques were mostly encountered in patients with ather othrombotic stroke. No specific findings by TEE were seen in patients with lacunar stroke. TEE is capable of detecting definite etiologies i n cardioembolic stroke and associated cardiac pathologies in atherothr ombotic stroke and lacunar stroke. These observations suggest that TEE is a useful tool to guide the physician for the treatment of ischemic stroke patients.