title: Single-vessel versus multivessel territory acute ischemic stroke: value of transesophageal echocardiography in the differentiation of embolic stroke.
abstract: OBJECTIVE
  We sought to assess the presence of potential aortic or cardiac sources of embolism in patients presenting with acute ischemic stroke in one or more vascular territories.
  
  
  BACKGROUND
  In patients with acute ischemic stroke, involvement of multiple vascular territories has been used to implicate a cardiac or aortic source of embolus. It remains unclear whether patients with multivessel stroke have a higher frequency of cardiac or aortic embolic sources on transesophageal echocardiography (TEE) compared with patients with single-territory stroke.
  
  
  METHODS
  We identified 210 patients with acute ischemic stroke documented by neuroimaging undergoing TEE for identification of a potential embolic source. Patients were divided into 3 groups (lacunar stroke, nonlacunar stroke/single-vessel involvement, nonlacunar stroke/multivessel involvement) and the frequency of potential embolic sources on TEE was compared.
  
  
  RESULTS
  Of the 210 patients, 121 (58%) were male and the mean age was 61 years. In all, 139 patients (66%) were classified as having single-vessel stroke, 47 (22%) as having multivessel stroke, and 24 (11%) as having lacunar stroke. On TEE, 87 patients (41%) had at least one potential source of embolism. Patients with multivessel strokes had fewer potential embolic sources on TEE than patients with single-vessel or lacunar strokes (26% vs 46% and 46%, respectively; P = .043).
  
  
  CONCLUSIONS
  In patients with acute ischemic stroke, the incidence of a potential cardiac or aortic source of embolism is high, regardless of the vascular distribution of the stroke. TEE may be a useful tool to assess the source of stroke in single-vessel, multivessel, and lacunar territory stroke distribution. We aimed to assess the presence of potential aortic or cardiac sources of embolism in patients presenting with acute ischemic stroke in one or more vascular territories. A total of 210 patients with acute ischemic stroke were divided into 3 groups (lacunar stroke, nonlacunar stroke/single-vessel involvement, nonlacunar stroke/multivessel involvement) and the frequency of potential embolic sources on transesophageal echocardiography was compared. Patients with multivessel strokes had fewer potential embolic sources on transesophageal echocardiography than patients with single-vessel or lacunar strokes, but the frequency of a potential cardiac or aortic source of embolism was high, regardless of the vascular distribution of stroke.
authors.affiliation: Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Jan Niklas
authors.initials: JN
authors.lastname: Ulrich
authors.forename: Barbara
authors.initials: B
authors.lastname: Hesse
authors.forename: Stephan
authors.initials: S
authors.lastname: Schuele
authors.forename: Irmien
authors.initials: I
authors.lastname: Vlassak
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Sila
authors.forename: Wael A
authors.initials: WA
authors.lastname: Jaber
mesh_terms: D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D017548:Echocardiography, Transesophageal / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*