Diagnosis of Right-to-Left Shunt: Possible Alternative ApproachesTo the Editor:We read with great interest the recent article by Del Sette et al 1 about diagnosis of right-to-left shunt with vertebrobasilar doppler examination.So far, neurologists used transtemporal recordings based on the manuscript by Teague and Sharma. 2 The emboli detection is in fact limited by insufficient temporal bone window in 10% to 20% of stroke patients. 3 A probably even greater limitation is the lack of transcranial examination expertise in local hospitals treating stroke patients. 4 Unfortunately, this issue cannot be solved by a transnuchal emboli detection technique.Recordings at the common carotid artery should be considered as a possible alternative technique. This method was already described by Draganski et al in 2005 5 but did not find its way into broad clinical practice. Performance and visualization of highintensity transient signals using contrast-enhanced harmonic carotid duplex and Doppler sonography are simple. Findings in a patient with a patent foramen ovale can be seen in the Figure. It might turn into a feasible option for local hospitals and for patients without a sufficient acoustic bone window in stroke centers if sensitivity and specificity will turn out to be comparable to the established methods. DisclosuresNone.
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