Low yield of clinically significant transesophageal echocardiographic findings in patients with lacunar stroke.
Transesophageal echocardiography (TEE) is a sensitive technique for the detection of cardioembolic sources of stroke in patients with cryptogenic stroke. However, the yield of clinically significant TEE-detected abnormalities in other stroke subtypes such as lacunar stroke is unknown. We prospectively followed 145 consecutive stroke patients, including 26 patients with typical lacunar syndromes, to determine the relative risk of recurrent brain ischemia associated with TEE findings. The yield of TEE in patients with lacunar stroke syndromes was extremely low, except for a very high rate of atrial septal aneurysm (ASA). Although ASA was associated with a high risk of recurrent stroke or transient ischemic attack in patients with nonlacunar stroke, ASA was not associated with stroke recurrence in patients with lacunar stroke (p = 0.02, Cox's proportional hazard regression model). We conclude that TEE is unlikely to provide clinically relevant information in patients with typical lacunar syndromes.
Stanford University School of Medicine, Stanford University, Stanford, CA.
A J
AJ
Golby
Stanford Stroke Center, Stanford University, Stanford, CA.
P M
PM
Bracci
Department of Internal Medicine/Cardiology, University of Washington Medical Center, Seattle, WA, U.S.A.; Department of Internal Medicine/Cardiology, Virginia Mason Medical Center, Seattle, WA, U.S.A.
K A
KA
Comess
Department of Internal Medicine/Cardiology, Virginia Mason Medical Center, Seattle, WA, U.S.A.
F A
FA
DeRook
Stanford Stroke Center, Stanford University, Stanford, CA; Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA.
G W
GW
Albers