Transcranial Doppler as a Primary Screening Tool for Detecting Right-to-Left Shunt in Cryptogenic Stroke Patients?

Area of Science:

• Neurology
• Cardiology
• Medical Imaging

Background:

• Cryptogenic stroke (CS) accounts for 25% of ischemic strokes with unknown causes.
• Patent foramen ovale (PFO) is a potential cause of CS through paradoxical embolism.
• Transesophageal echocardiography (TEE) is the gold standard for PFO detection, but transcranial Doppler (TCD) ultrasound offers a noninvasive alternative.

Purpose of the Study:

• To evaluate the diagnostic performance of TCD compared to TEE for PFO detection in CS patients.
• To assess TCD's sensitivity and specificity in identifying right-to-left shunts (RLS) indicative of PFO.

Main Methods:

• 110 CS patients (aged 18-65) underwent TCD screening for RLS.
• Patients were categorized using the Spencer Logarithmic Scale, followed by confirmatory TEE.
• Clinical data, imaging, TCD results, and PFO closure indications were analyzed.

Main Results:

• TEE identified PFO in 44.5% of patients.
• TCD accurately detected RLS in 85.7% of PFO cases identified by TEE.
• TCD demonstrated a sensitivity of 85.4% and specificity of 88.5% for PFO detection.

Conclusions:

• TCD shows high diagnostic accuracy for detecting high-risk PFO in CS patients compared to TEE.
• TCD can serve as an effective, noninvasive screening tool for CS patients.
• Findings support using TCD to triage patients for confirmatory TEE and potential PFO closure.