Transesophageal echocardiography in patients with ischemic stroke accurately detects significant coronary artery stenosis and often changes management

Objectives TEE is performed in many patients with ischemic stroke, and it i s possible to examine the proximal coronaries by TEE in these patients. Our purpose was to (1) determine the accuracy of transesophageal echocardiogra phy (TEE) in the diagnosis of proximal coronary stenosis in patients with i schemic stroke and (2) show that TEE detection of proximal coronary stenosi s changed management in a substantial number of patients. Methods Thirty-two patients with ischemic stroke undergoing TEE, in whom th e proximal coronaries were examined and who had angiographic results availa ble, were studied. Results Proximal coronaries were visualized as follows: left main (LM) in 3 1 (97%), left anterior descending (LAD) in 32 (100%), left circumflex (LCx) in 30 (94%) and right coronary artery (RCA) in 21 (66%). The sensitivity a nd specificity of TEE in diagnosing significant coronary stenosis in visual ized vessels were as follows: LM 100% and 100%, LAD 100% and 95%, LCx 100% and 96%, and RCA 100% and 100%, respectively. When visualized and nonvisual ized segments were considered, TEE detected significant stenosis as follows : 4 of 5 in the LM (80%), 13 of 13 in the LAD (100%), 2 of 3 in the LCx (66 %), and 2 of 8 in the RCA (25%). Of the 32 patients, TEE results changed ma nagement in 17 patients (53%). Angiographic findings resulted in 10 of the 17 patients (59%) undergoing revascularization. Conclusions TEE was very accurate in diagnosing significant coexisting coro nary artery disease in patients with ischemic stroke. TEE diagnosis of thes e lesions prompted coronary angiography and subsequent revascularization in a substantial number of patients.