Disclosures: SAG – none.ILK – Consultant: Pfizer, Genentech. Honoraria: Cardionet. RG: Consultant/Scientific Advisory Board: CoAxia, Rapid Medical, Concentric Medical. Data Safety Monitoring Board: Reverse Medical and Rapid Medical.
Transcranial Doppler with Bubble Study as a Method to Detect Extracardiac Right-to-Left Shunts in Patients with Ischemic Stroke
Version of Record online: 28 AUG 2012
Copyright © 2012 by the American Society of Neuroimaging
Journal of Neuroimaging
Volume 23, Issue 4, pages 523–525, October 2013
How to Cite
Goutman, S. A., Katzan, I. L. and Gupta, R. (2013), Transcranial Doppler with Bubble Study as a Method to Detect Extracardiac Right-to-Left Shunts in Patients with Ischemic Stroke. Journal of Neuroimaging, 23: 523–525. doi: 10.1111/j.1552-6569.2012.00738.x
Funding Sources: None.
- Issue online: 15 OCT 2013
- Version of Record online: 28 AUG 2012
- Manuscript Accepted: 22 MAY 2012
- Manuscript Revised: 12 MAY 2012
- Manuscript Received: 30 MAR 2012
- Transcranial doppler;
- cryptogenic stroke;
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.
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.
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.
TCD-bubble studies may prove useful in uncovering treatable causes of stroke.