EARLY TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN CRYPTOGENIC AND LACUNAR STROKE AND TRANSIENT ISCHEMIC ATTACK

Objectives-To test the hypothesis that transoesophageal echocardiograp hy (TOE) carried out within three days of a first stroke or transient ischaemic attack of cryptogenic or lacunar type may disclose more thro mbi or spontaneous echo contrast (SEC) than previously reported. This finding may help early treatment decisions. Methods-Patients aged betw een 40 and 80 years, admitted for transient ischaemic attack or ischae mic stroke during a 40 month period, were prospectively considered. TO E was carried out within 72 hours of symptom onset with a 5 MHz biplan ar transducer. Subjects with recurring events, very severe strokes, la rge artery obstructions, or obvious cardiac sources of embolism were e xcluded. Results-Sixty five patients were studied, 43 with a cryptogen ic stroke or transient ischaemic attack (66.2%), and 22 with a lacunar stroke (33.8%). The mean (SD) interval between symptom onset and TOE was 43.4 (17.2) hours for cryptogenic, and 48.5 (19.5) hours for lacun ar patients. Atrial thrombi were found in one patient with a cryptogen ic stroke (2.32% of cryptogenic events; 95% confidence interval 0.06-1 2.29), whereas SEC was found in five patients (7.7% overall), two with a lacunar and three with a cryptogenic stroke. Conclusions-An early T OE does not seem to increase substantially the detection of atrial thr ombi or SEC in patients with a first stroke or transient ischaemic att ack of cryptogenic or lacunar nature. Therefore, this examination can be carried out when the patients' conditions are stable, and without o verloading the cardiovascular laboratory daily schedule.