Treatable potential cardiac sources of embolism in patients with cerebral ischemic events: a selective transesophageal echocardiographic study.
OBJECTIVE
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.
Yahia
Abutaher M
AM
Department of Neurology and Neurosciences, University of Medicine and Dentistry, New Jersey Medical School, Newark, NJ, USA. yahia25@hotmail.com
Shaukat
Aasma B
AB
Kirmani
Jawad F
JF
Xavier
Andrew
A
Manalio
Nancy G
NG
Qureshi
Adnan I
AI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging; D013923:Thromboembolism / Q000209:etiology*