Transesophageal echocardiography and carotid ultrasound in patients with cerebral ischemia: prevalence of findings and recurrent stroke risk

J Am Coll Cardiol. 1994 Jun;23(7):1598-603. doi: 10.1016/0735-1097(94)90662-9.


Objectives: This study was conducted to determine the yield of transesophageal echocardiographic findings in a consecutive series of patients with stroke and transient ischemic attack, with and without carotid stenosis, and to estimate the recurrent stroke risk associated with specific echocardiographic findings.

Background: Transesophageal echocardiography has a high yield for identification of potential sources of cardiac embolism in patients with cerebral ischemia; however, the clinical significance of the most commonly detected abnormalities is uncertain.

Methods: We evaluated 145 consecutively admitted patients with stroke or transient ischemic attack with both transesophageal echocardiography and carotid ultrasound. Patients were followed up prospectively for a mean duration of 18 months to document the rate of recurrent cerebral ischemia.

Results: Transesophageal echocardiography detected at least one potential cardiac source of embolism in 45% of the patients. Atrial septal aneurysm and interatrial shunt were detected more frequently in patients who did not have a significant carotid stenosis that could account for their ischemic event. During follow-up, a higher rate of recurrent stroke or transient ischemic attack occurred in patients with positive transesophageal echocardiographic findings, particularly atrial septal aneurysm, interatrial shunt and left atrial thrombus.

Conclusions: These data support recent studies that suggest that atrial septal aneurysm and interatrial shunts may be a significant source of cardioembolic stroke. Further studies are needed to clarify the optimal management of patients with these abnormalities.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Carotid Stenosis / complications
  • Carotid Stenosis / diagnostic imaging*
  • Cerebrovascular Disorders / diagnostic imaging*
  • Coronary Aneurysm / complications
  • Coronary Aneurysm / diagnostic imaging
  • Echocardiography, Transesophageal*
  • Female
  • Humans
  • Ischemic Attack, Transient / diagnostic imaging*
  • Male
  • Middle Aged
  • Prospective Studies
  • Recurrence
  • Risk Factors