Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke

Harloff, Andreas; Handke, Michael; Reinhard, Matthias; Geibel, Annette; Hetzel, Andreas

doi:10.1161/01.str.0000202592.87021.b7

Cited by 128 publications

(128 citation statements)

References 39 publications

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“…In our study, 28% of our study population had a complex aortic atheroma in the ascending aorta and arch, this was higher than that detected by Harloff et al (14) . In their study, TEE was performed on 503 ischemic stroke patients.They detected complex aortic atheroma in 19.7%.…”

Section: **Motor Deficitcontrasting

confidence: 68%

Transesophageal Echo Study in Patients With Acute Ischemic Stroke

Mansour

Elzaki

El-Sharkawy

et al. 2014

Zagazig University Medical Journal

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Background: Stroke is one of the major causes of death and disability and due to the high mortality and morbidity rates associated with stroke ,it is becoming a major community health problem worldwide. It has been estimated that cardiogenic emboli are a source of transient ischemic attack (TIA) or stroke in 20% to 40% of all cases. Transesophageal echocardiography (TEE) has been proven superior to transthoracic echocardiography (TTE) for the detection of potential sources of cardiac embolism in patients with previous stroke. In particular, the additional value of TEE in the patients above 45 years of age, in whom TEE is still far from routine procedure, was evaluated. In addition, emphasis was placed on therapeutic consequences, ie, the indication for anticoagulation, based on the results of TEE. Aim of the work : The aim of our study is to evaluate the role of TEE (transesophagealecho) to find indications of anticoagulation despite false absence of its benefit by clinical and transthoracicecho (TTE) examination. Patient and methods:The study was conducted in Zagazig university hospitals and included 100 patients diagnosed with ischemic stroke The diagnosis of stroke was made based on clinical data and brain CT. A full TEE was done and the presence of the following potential sources of embolism was specifically examined (a)left atrial spontaneous echo contrast and thrombus , (b)Impaired Left atrial appendage velocity and the presence of LAA (Left atrial appendage )thrombi , (c)Atheroma in the thoracic aorta, (d)Patent foramen ovale and atrial septal aneurysm (e) others, including valvular vegetations and intracardiac masses . Results:Among the different age groups studied , the prevalence of PFO and MVP (mitral valve prolapse) were highest in patients ˂ 45 years old while the prevalence of complex aortic atheroma was highest in patients ˃45 years old .Risk of stroke recurrence was highest in patients with complex aortic atheroma .Among patients with dyslipidemia,prevalance of ischemic stroke was highest in those older than 45 years old and was significantly higher in low HDL (high density lipoprotein ) (˂40 mg/dl ) and high cholesterol (˃200 mg/dl) group.Furthermore, the risk of stroke recurrence was significantly higher in patients with hypercholesterolemia. Conclusion: TEE has proved to be a very useful tool in diagnosing causes of ischemic stroke .The benefit was not only seen in young age (˂45 years old), but also in those in older age groups .

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Section: **Motor Deficitcontrasting

confidence: 68%

Transesophageal Echo Study in Patients With Acute Ischemic Stroke

Mansour

Elzaki

El-Sharkawy

et al. 2014

Zagazig University Medical Journal

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“…Large studies showed that in an older population TEE strongly influenced secondary prevention and led to oral anticoagulation in one third of the patients with a stroke of undetermined aetiology. 5,6 However, in the young patient the prevalence of findings for which oral anticoagulation is indicated is much lower. Moreover, TEE is a diagnostic tool that, although semi-invasive, can cause considerable discomfort especially in the young.…”

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confidence: 99%

Influence of transoesophageal echocardiography on therapy and prognosis in young patients with TIA or ischaemic stroke

Rettig¹,

Bouma²,

Brink³

2009

NHJL

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Objective. To determine the influence of transoesophageal echocardiography (TEE) on therapy and prognosis in patients with cryptogenic transient ischaemic attack (TIA) or ischaemic stroke under the age of 50 years. Methods and results. We evaluated all patients aged 50 and under who were referred to our university hospital for cryptogenic TIA or ischaemic stroke during the period 1 January 1996 to 31 December 2004. All patients underwent both transthoracic echocardiography (TTE) and TEE. Patients with known pre-existent heart disease, such as atrial fibrillation, were excluded. Eighty-three patients with TIA (22) and ischaemic stroke (61) were enrolled. Mean age was 39±8 years (range 18 to 50). In 30% of the patients TEE detected one or more potential cardioembolic source, compared with 10% for TTE (p=0.003). Standard treatment (aspirin 38 mg daily) was changed in 7% of the patients due to the TEE findings. Complete followup was obtained in 93% with an average of 5±3 years. Twelve recurrences occurred; two out of six patients (33%) with therapy change and ten out of 71 (14%) of the patients without therapy change had a recurrent TIA or ischaemic stroke. Conclusion. In patients with cryptogenic TIA or ischaemic stroke, TEE is superior to TTE in the detection of a potential cardiac source of embolism.

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“…Cardiac imaging with echocardiography is invaluable in an acute diagnosis (114 echocardiography is unrevealing and no arrhythmias are detected on telemetry during hospitalization, extended outpatient rhythm monitoring should be considered (115). Rare causes of stroke include non-atherosclerotic vasculopathies, hypercoagulable states, or hematologic disorders (14).…”

Section: Etiology Workupmentioning

confidence: 99%