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Objectives. Transesophageal echocardiography (TEE) is superior to transthoracic echocardiography
(TTE) in diagnosing cardiac abnormalities that may result in cerebral embolism. The
clinical importance of these abnormalities is unclear. Methods. We classified 96 consecutive stroke patients into high- or low-risk groups for cardioembolism
based on historical criteria. The presence of left atrial thrombus, atrial smoke,
patent foramen ovale, atrial septal aneurysm, and plaque in the ascending aorta was
assessed with TEE. Stroke type and other possible stroke mechanisms were evaluated.
Results. Left atrial thrombus occurred only in the high-risk group. Patent foramen ovale,
atrial septal aneurysm, and most cases of left atrial smoke occurred in the presence
of another embolic source or were associated with a stroke related to hypertensive
small vessel disease. Protruding atherosclerotic plaque in the ascending aorta and
aortic arch was the most significant cause of stroke diagnosed by TEE because it frequently
occurred in those without other risk factors for stroke. TEE identified aortic plaque
in one and left atrial smoke in two patients with lacunar infarction without risk
factors for small vessel disease. Conclusions. TEE should be considered in both lacunar and nonlacunar stroke that occur in the
absence of stroke risk factors, although optimal management of most TEE findings is
yet to be determined.
Key words
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Article info
Publication history
Accepted:
January 9,
1997
Received:
September 16,
1996
Identification
Copyright
© 1997 National Stroke Division. Published by Elsevier Inc.
