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Transcranial Doppler with Bubble Study as a Method to Detect Extracardiac Right‐to‐Left Shunts in Patients with Ischemic Stroke
Author(s) -
Goutman Stephen A.,
Katzan Irene L.,
Gupta Rishi
Publication year - 2013
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.1552-6569.2012.00738.x
Subject(s) - medicine , paradoxical embolism , transcranial doppler , transesophageal echocardiogram , cardiology , stroke (engine) , right to left shunt , transthoracic echocardiogram , patent foramen ovale , thrombus , radiology , mechanical engineering , migraine , engineering
BACKGROUND AND PURPOSE Paradoxical embolism through extracardiac right‐to‐left shunts (ECRLS) may represent an under‐detected stroke mechanism. Stroke patients without evidence of cardiac right‐to‐left shunt (RLS) on echocardiogram may benefit from transcranial Doppler with bubble study (TCD‐b) to aid in recognition of stroke etiology. This study assesses the usefulness of TCD‐b in the stroke evaluation. METHODS Retrospective cohort study of consecutive patients undergoing TCD‐b performed in our neurovascular laboratory from February 2005 to August 2009. Echocardiography results were reviewed in patients with positive TCD‐b. Detailed medical record review was performed on patients with positive TCD‐b and negative echocardiogram findings for RLS. RESULTS Of 502 patients undergoing TCD‐b, 48.4% ( n = 243) had a positive study suggesting the presence of RLS. Of these, 59.2% ( n = 144) had an echocardiogram demonstrating a cardiac RLS, 26% ( n = 63) had echocardiograms without evidence of cardiac RLS, and 14.8% ( n = 36) had no echocardiogram. Data on the evaluation to determine source of potential shunting in patients with discrepant findings was available in 11(17.5%). Of these, 63.6% (7/11) had potential mechanisms for positive TCD‐b: one pulmonary arteriovenous malformation (AVM), one arteriovenous fistula thrombus, one parietal AVM, and four had malignancy. CONCLUSIONS TCD‐bubble studies may prove useful in uncovering treatable causes of stroke.