Transesophageal echocardiographic diagnosis of proximal coronary artery stenosis in patients with ischemic stroke

Atherosclerosis is the leading cause of death worldwide. It encompasses sev eral clinical entities, including coronary artery disease and cerebrovascul ar disease. Because the underlying pathophysiological mechanism is the same , coronary artery disease and cerebrovascular disease frequently coexist. T ransesophageal echocardiography (TEE) is routinely done in patients with is chemic stroke to exclude possible cardiac sources of cerebral embolism. Sin ce the introduction of multiplane transesophageal transducers, it has becom e easier to visualize the proximal coronary arteries during transesophageal examinations. We report three cases in which routine TEE for ischemic stro ke revealed significant coronary artery disease that was not previously sus pected. In. one patient, the stroke was so severe that further evaluation, of the coronary artery disease was not deemed useful. The other two patient s underwent coronary angiography based on the echocardiographic findings, c onfirming the lesions noted on the echocardiogram. Subsequently, both patie nts were successfully revascularized: one by percutaneous transluminal coro nary angioplasty and the other by coronary artery bypass graft surgery. We conclude that the examination of coronary arteries during routine TEE for i schemic stroke may become a useful screening tool for the detection of coex isting, asymptomatic, significant proximal coronary artery disease.