title: [Usefulness of transesophageal echocardiography to optimize treatment after ischemic stroke].
abstract: OBJECTIVE
  In the setting of ischemic stroke, the place of transesophageal echocardiography (TEE) is still matter of debate. The aim of the study is to evaluate the therapeutic impact provided by TEE and to characterize patients in whom TEE is warranted.
  
  
  METHODS
  Three hundred and fifty-nine consecutive patients were included in the study. "Decisive TEE" (DTEE) was defined by echographic findings resulting in a change of treatment, whereas "informative TEE" (ITEE) was defined by TEE revealing a potential cardiac or aortic source of embolism.
  
  
  RESULTS
  Three hundred and forty-one patients underwent TEE. Twenty-eight patients (8.2%) had DTEE and 184 (53.9%) had ITEE. DTEE were as follows: thrombus in the left atrial appendage in 6 patients, complex aortic plaques in 10 patients, patent foramen ovale (PFO) associated with atrial septal aneurism (ASA) and an important right to left shunt (3 patients), FOP associated with ASA and lower limb phlebitis (1 patient), 4 cases of endocarditis and 4 patients with intense spontaneous echo contrast in the left atrium. In most cases of DTEE (67.8%), the patient was given anticoagulation drugs. Left atrial dilatation (P=0.005) and multivessel territory stroke (P=0.018) were statistically predictive of DTEE.
  
  
  CONCLUSIONS
  In the setting of ischemic stroke, TEE provides important additional informations, but modifies therapeutic strategy in less than 10% of cases. Multivessel territory stroke, and left atrial dilatation were predictive of DTEE.
authors.affiliation: Service de cardiologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France. Electronic address: ccharbonnel@ch-versailles.fr.
authors.forename: C
authors.initials: C
authors.lastname: Charbonnel
authors.affiliation: Service de cardiologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
authors.forename: L
authors.initials: L
authors.lastname: Fanon
authors.affiliation: Service de cardiologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Georges
authors.affiliation: Service de cardiologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
authors.forename: G
authors.initials: G
authors.lastname: Colonna
authors.affiliation: Service de cardiologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
authors.forename: L
authors.initials: L
authors.lastname: Stefas
authors.affiliation: Service de cardiologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
authors.forename: C
authors.initials: C
authors.lastname: Isorni
authors.affiliation: Service de cardiologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
authors.forename: R
authors.initials: R
authors.lastname: Convers-Domart
authors.affiliation: Service de cardiologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
authors.forename: G
authors.initials: G
authors.lastname: Galuscan
authors.affiliation: Service de cardiologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
authors.forename: N
authors.initials: N
authors.lastname: Baron
authors.affiliation: Service de neurologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
authors.forename: F
authors.initials: F
authors.lastname: Pico
authors.affiliation: Service de cardiologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
authors.forename: B
authors.initials: B
authors.lastname: Livarek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D020517:Atrial Appendage / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: Accident vasculaire cérébral ischémique; Accident vasculaire cérébral multi-territoire; Anti-thrombotic therapy; Ischemic stroke; Multivessel territory acute ischemic stroke; Thérapeutique anti-thrombotique; Transesophageal echocardiography; Échocardiographie trans-œsophagienne