What is Clinical Efficacy of Transesophageal Echocardiography in Patients With Cryptogenic Stroke? A Critically Appraised Topic

Michael E. Christiansen, Ryan C. Van Woerkom, Bart M Demaerschalk, Dean Marko Wingerchuk, Cumara B. O'Carroll

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Adults with cryptogenic stroke often undergo transesophageal echocardiogram (TEE) because this is the gold-standard for evaluation of potential proximal sources of emboli. The risks of performing this invasive test must be weighed against its clinical efficacy and limitations, determined by the rate of positive findings, and the impact on clinical outcome for the patient. Objective: To critically appraise current evidence regarding the rate of positive TEE findings in cryptogenic stroke patients, and analyze the implications of these findings on management decisions and outcomes. Methods: The objective was addressed through the development of a structured, critically appraised topic. We incorporated a clinical scenario, background information, a structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, and vascular neurology and cardiology content experts. Results: TEE commonly identifies abnormalities, including aorta atherosclerosis in 51%, patent foramen ovale in 43%, and atrial septal aneurysm in 13% of patients. Findings such as left-sided chamber thrombus or intracardiac tumor that definitively warrant a change in management by guideline-supported use of anticoagulation are less common, occurring in ∼3% of patients. Conclusions: TEE identifies potential causal sources of embolus in patients with cryptogenic stroke that leads to changes in management and outcomes at least 3% of the time. Other findings, particularly aorta atherosclerosis, are identified much more commonly but the causal link to stroke is uncertain, thus changes in management in these cases is variable and data describing resulting outcomes are lacking.

Original languageEnglish (US)
Pages (from-to)30-33
Number of pages4
JournalNeurologist
Volume23
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Transesophageal Echocardiography
Stroke
Embolism
Aorta
Atherosclerosis
Librarians
Patent Foramen Ovale
Case Management
Neurology
Consultants
Cardiology
Gold
Aneurysm
Blood Vessels
Thrombosis
Guidelines
Neoplasms

Keywords

  • cryptogenic stroke
  • embolic stroke of undetermined source
  • evidence-based medicine
  • transesophageal echocardiogram

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

What is Clinical Efficacy of Transesophageal Echocardiography in Patients With Cryptogenic Stroke? A Critically Appraised Topic. / Christiansen, Michael E.; Van Woerkom, Ryan C.; Demaerschalk, Bart M; Wingerchuk, Dean Marko; O'Carroll, Cumara B.

In: Neurologist, Vol. 23, No. 1, 01.01.2018, p. 30-33.

Research output: Contribution to journalArticle

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