Impact of transesophageal echocardiogram on the management of acute stroke.
The etiology of cardioembolism is established in only a small percentage of patients. With the recent availability of transesophageal echocardiography (TEE), the detection of a cardiac source has increased, but the usefulness of this added sensitivity is not well established. We recently reported that TEE may show a potential cardiacsource in41% of patients with stroke. This resulted in a change in therapy in only 5% of patients. We now report the reasons for this low impact of the use of TEE in patients with acute stroke. Patients already on anticoagulants, poor risk for anticoagulant therapy, and another more obvious etiology for the stroke were the most common reasons for not changing therapy. Our study suggests that TEE should be reserved for patients with acute stroke in whom an etiology is not evident and in whom detecting a cardiac source would lead to a change in therapy.
From the Division of Neurology, Department of Medicine, Royal University Hospital.
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Mosewich
From the Division of Neurology, Department of Medicine, Royal University Hospital.; The Saskatchewan Stroke Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Shuaib
The Division of Cardiology, Department of Medicine, Royal University Hospital.
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Cujec
The Division of Cardiology, Department of Medicine, Royal University Hospital.
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Polasek