Echocardiography in patients with symptomatic intracranial stenosis

Echocardiography is often performed in patients with stroke, even when alternative stroke causes are identified. We evaluated the use of echocardiography in patients with transient ischemic attack (TIA) or stroke caused by stenosis of a major intracranial artery.

The Warfarin Versus Aspirin for Symptomatic Intracranial Disease (WASID) trial was a National Institutes of Health-funded, randomized, double-blind, multicenter clinical trial in which 569 patients with TIA or ischemic stroke attributed to angiographically proven 50% to 99% stenosis of a major intracranial artery were randomly assigned to warfarin or aspirin. Patients with unequivocal cardiac sources of embolism were excluded. The risk of ischemic stroke, myocardial infarction, and vascular death was compared among patients who had or did not have echocardiography performed before enrollment, and Cox proportional hazards models were used to determine whether echocardiographic abnormalities present in greater than 5% of patients were associated with these outcomes.

In all, 264 of 569 patients in WASID had echocardiograms; 37% were transesophageal. Of these 264 patients, 69 had subsequent ischemic stroke, myocardial infarction, or vascular death. Patients who underwent echocardiography had similar event rates to those who did not (P = .18). Common abnormalities identified on echocardiography were not associated with subsequent risk in this population.

Among patients with TIA or stroke caused by intracranial arterial stenosis, echocardiography appears to offer limited diagnostic and prognostic value.