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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Impact of transesophageal echocardiogram on the management of acute stroke
R K Mosewich1, A Shuaib2, B Cujec3
1From the Division of Neurology, Department of Medicine, Royal University Hospital.
Insights
Transesophageal echocardiography (TEE) detects cardiac sources in 41% of stroke patients, but therapy changes occur in only 5%. TEE is most useful when stroke etiology is unclear and findings would alter treatment.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Establishing the etiology of cardioembolic stroke is challenging.
- Transesophageal echocardiography (TEE) increases cardiac source detection but its clinical impact is debated.
Purpose of the Study:
- To investigate the reasons behind the low impact of TEE on therapy changes in acute stroke patients.
- To define optimal patient selection for TEE in acute stroke.
Main Methods:
- Retrospective analysis of acute stroke patients undergoing TEE.
- Evaluation of reasons for not altering therapy despite potential cardiac source identification.
Main Results:
- TEE identified potential cardiac sources in 41% of patients.
- Therapy changed in only 5% of patients due to factors like existing anticoagulation or alternative stroke etiologies.
- Common reasons for no therapy change included patients already on anticoagulants, high bleeding risk, or a more apparent stroke cause.
Conclusions:
- Transesophageal echocardiography (TEE) should be reserved for acute stroke patients with an undetermined etiology.
- TEE utility is maximized when positive findings would directly influence patient management and therapy.
Abstract:
The etiology of cardioembolism is established in only a small percentage of patients. With the recent availability of transesophageal echocardiography (TEE), the detection of a cardiac source has increased, but the usefulness of this added sensitivity is not well established. We recently reported that TEE may show a potential cardiacsource in41% of patients with stroke. This resulted in a change in therapy in only 5% of patients. We now report the reasons for this low impact of the use of TEE in patients with acute stroke. Patients already on anticoagulants, poor risk for anticoagulant therapy, and another more obvious etiology for the stroke were the most common reasons for not changing therapy. Our study suggests that TEE should be reserved for patients with acute stroke in whom an etiology is not evident and in whom detecting a cardiac source would lead to a change in therapy.
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