Treatable potential cardiac sources of embolism in patients with cerebral ischemic events: A selective transesophageal echocardiographic study

Abutaher M. Yahia, Aasma B. Shaukat, Jawad F. Kirmani, Andrew Xavier, Nancy G. Manalio, Adnan I. Qureshi

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Objectives: To characterize cardiac sources of emboli detected by transesophageal echocardiography (TEE) in patients without recognizable cause of transient ischemic attack (TIA) and/or ischemic stroke and TIA. Methods: We examined a prospective registry that included all patients with TIA and/or stroke evaluated by TEE between July 2000 and August 2001 at our medical center. Ischemic events were classified according to clinical and neuroimaging findings as cortical, lacunar, or vertebrobasilar circulation. Demographic, clinical, neuroimaging, and echocardiographic characteristics were studied. Results: TEE was performed in 237 patients without recognized cause of TIA and/or stroke, of which 105 (44%) events were cortical, 35 (15%) were lacunar, 32 (14%) were vertebrobasilar, and 65 (27%) were in multiple distributions. Mean age of patients was 59 ± 14 years (range, 21 to 93 years); 119 (51%) were men. Potential treatable cardioembolic sources were detected in 146 (61%) patients: patent foramen ovale with right-to-left shunt (n = 59), left atrial clot (n = 6), left atrial appendage clot (n = 8), and severe thoracic aortic atherosclerotic plaque disease (plaque thickness >4 mm) (n = 79 patients [33%], 56 had an ulcerated plaque and 4 had mobile plaque). Patient age and topography of the ischemic event did not correlate with TEE-defined cardioembolic sources. Conclusions: TEE identified high frequencies of potential treatable cardioembolic sources in patients with ischemic events. TEE should be considered in all patients who do not have identified cause of TIA and/or stroke for early treatment and prevention of recurrent events.

Original languageEnglish (US)
Pages (from-to)1055-1059
Number of pages5
JournalSouthern Medical Journal
Volume97
Issue number11
DOIs
StatePublished - Nov 1 2004

Keywords

  • Atrial thrombus
  • Cardioembolic sources
  • Patent foramen ovale
  • Thoracic aortic plaque
  • Transesophageal echocardiography
  • Transient ischemic attack

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