BACKGROUND AND PURPOSE: A recent retrospective study using an online list service established by the American Academy of Neurology has suggested that ischaemic cerebrovascular events may occur in patients who undergo 'bubble studies' (BS) with either transcranial Doppler (TCD) or transoesophageal echocardiography (TOE). The safety of TCD-BS for right to left shunt (RLS) identification was evaluated prospectively in an international multicentre study. METHODS: Consecutive patients with cerebral ischaemia (ischaemic stroke or transient ischaemic attack (TIA)) were screened for potential ischaemic cerebrovascular events following injection of microbubbles during TCD-BS for identification of RLS at three tertiary care stroke centres. TCD-BS was performed according to the standardised International Consensus Protocol. TOE-BS was performed in selected cases for confirmation of TCD-BS. RESULTS: 508 patients hospitalised with acute cerebral ischaemia (mean age 46±12 years, 59% men; 63% ischaemic stroke, 37% TIA) were investigated with TCD-BS within 1 week of ictus. RLS was identified in 151 cases (30%). TOE-BS was performed in 101 out of 151 patients with RLS identified on TCD-BS (67%). It was positive in 99 patients (98%). The rate of ischaemic cerebrovascular complications during or after TCD-BS was 0% (95% CI by the adjusted Wald METHOD: 0-0.6%). Structural cardiac abnormalities were identified in 38 patients, including atrial septal aneurysm (n=23), tetralogy of Fallot (n=1), intracardiac thrombus (n=2), ventricular septal defect (n=3) and atrial myxoma (n=1). CONCLUSION: TCD-BS is a safe screening test for identification of RLS, independent of the presence of cardiac structural abnormalities.
BACKGROUND AND PURPOSE: A recent retrospective study using an online list service established by the American Academy of Neurology has suggested that ischaemic cerebrovascular events may occur in patients who undergo 'bubble studies' (BS) with either transcranial Doppler (TCD) or transoesophageal echocardiography (TOE). The safety of TCD-BS for right to left shunt (RLS) identification was evaluated prospectively in an international multicentre study. METHODS: Consecutive patients with cerebral ischaemia (ischaemic stroke or transient ischaemic attack (TIA)) were screened for potential ischaemic cerebrovascular events following injection of microbubbles during TCD-BS for identification of RLS at three tertiary care stroke centres. TCD-BS was performed according to the standardised International Consensus Protocol. TOE-BS was performed in selected cases for confirmation of TCD-BS. RESULTS: 508 patients hospitalised with acute cerebral ischaemia (mean age 46±12 years, 59% men; 63% ischaemic stroke, 37% TIA) were investigated with TCD-BS within 1 week of ictus. RLS was identified in 151 cases (30%). TOE-BS was performed in 101 out of 151 patients with RLS identified on TCD-BS (67%). It was positive in 99 patients (98%). The rate of ischaemic cerebrovascular complications during or after TCD-BS was 0% (95% CI by the adjusted Wald METHOD: 0-0.6%). Structural cardiac abnormalities were identified in 38 patients, including atrial septal aneurysm (n=23), tetralogy of Fallot (n=1), intracardiac thrombus (n=2), ventricular septal defect (n=3) and atrial myxoma (n=1). CONCLUSION:TCD-BS is a safe screening test for identification of RLS, independent of the presence of cardiac structural abnormalities.
Authors: Jukka Putaala; Nicolas Martinez-Majander; Sahrai Saeed; Nilufer Yesilot; Pekka Jäkälä; Ossi Nerg; Georgios Tsivgoulis; Heikki Numminen; Daniel Gordin; Bettina von Sarnowski; Ulrike Waje-Andreassen; Pauli Ylikotila; Risto O Roine; Marialuisa Zedde; Juha Huhtakangas; Catarina Fonseca; Petra Redfors; Frank-Erik de Leeuw; Alessandro Pezzini; Janika Kõrv; Siim Schneider; Christian Tanislav; Christian Enzinger; Dalius Jatuzis; Bob Siegerink; Patricia Martínez-Sánchez; Armin J Grau; Frederick Palm; Per-Henrik Groop; Sylvain Lanthier; Hugo Ten Cate; Pirkko Pussinen; Susanna Paju; Juha Sinisalo; Mika Lehto; Arne Lindgren; José Ferro; Steven Kittner; Franz Fazekas; Eva Gerdts; Turgut Tatlisumak Journal: Eur Stroke J Date: 2017-04-04
Authors: Pauli Pöyhönen; Jouni Kuusisto; Jani Pirinen; Heli Räty; Lauri Lehmonen; Riitta Paakkanen; Nicolas Martinez-Majander; Eva Gerdts; Jukka Putaala; Juha Sinisalo; Vesa Järvinen Journal: Open Heart Date: 2021-05
Authors: Ernst Mayerhofer; Dirk Kanz; Brigitte Guschlbauer; Christopher D Anderson; Alexander Asmussen; Sebastian Grundmann; Christoph Strecker; Andreas Harloff Journal: Front Neurol Date: 2022-03-04 Impact factor: 4.003