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Right‐to‐Left‐Shunt Detected by c‐TCD Using the Orbital Window in Comparison with Temporal Bone Windows
Author(s) -
Kobayashi Kazuto,
Kimura Kazumi,
Iguchi Yasuyuki,
Sakai Kenichirou,
Aoki Junya,
Iwanaga Takeshi,
Shibazaki Kensaku
Publication year - 2012
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2010.00518.x
Subject(s) - medicine , transcranial doppler , middle cerebral artery , temporal bone , window (computing) , shunt (medical) , right to left shunt , internal carotid artery , cardiology , radiology , surgery , ischemia , patent foramen ovale , percutaneous , computer science , operating system
PURPOSE There have been some reports on right‐to‐left shunt as a cause of cryptogenic stroke. Although contrast transcranial Doppler (c‐TCD) can detect RLS, an insufficient temporal window has occasionally restricted its applicability. Thus, we compared the rates of detecting RLS among temporal windows for the middle cerebral arteries (MCAs) and the orbital window for the internal carotid artery (ICA) on c‐TCD. METHODS We used c‐TCD to detect RLS in patients with suspected ischemic stroke. We enrolled patients who had both sufficient bilateral temporal windows for MCAs and a right orbital window for ICA and performed c‐TCD using all three windows simultaneously. RESULTS We enrolled 106 consecutive patients and identified microembolic signals (MES) in 30 (28%) of them. Among these 30 patients, 15 had MES from all 3 windows. When these 30 patients were defined as being positive for RLS, the rates of detection were 67%, 73%, and 80% from the right temporal, left temporal, and right orbital windows, respectively ( P = .795). CONCLUSION The right orbital window as well as the temporal window for c‐TCD could detect RLS. Insonation from the orbital window should be useful for patients who lack temporal windows.