title: Acute Bilateral Internal Carotid Occlusion from Embolization of Left Atrial Thrombus During Transesophageal Echocardiography: Case Report.
abstract: OBJECTIVE
  Transesophageal echocardiography (TEE) is a relatively safe imaging modality used to visualize intracardiac thrombus.
  
  
  METHODS
  We report on a unique, fatal complication during TEE of embolization of a pre-existing "smoking" left atrial thrombus causing acute bilateral internal carotid occlusion, confirmed on angiogram.
  
  
  CONCLUSIONS
  Patients with history of lung pathology, such as COPD, who experience retching and cough during transesophageal echocardiography may be more susceptible to embolization of pre-existing thrombi. A need exists to risk stratify such patients.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Syed Saad
authors.initials: SS
authors.lastname: Mahmood
authors.affiliation: Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Manjila
authors.affiliation: Department of Neurology, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Singh
authors.affiliation: Department of Neurosurgery, Wayne State University, Detroit, MI, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Xavier
keywords: Cardioembolic; echocardiography; stroke; transesophageal