Ischemic stroke:: Transesophageal echocardiographic findings

Introduction. Since its initial application in 1976, the transesophageal echocardiogram (TEE) has improved the detection of cardiovascular emholigenic sources. Even though its indication inpatients with stroke is still controversial, its use has contributed to the identification of potential embolic stroke sources. Objective. To describe the transesophageal echocardiographic findings in ischemic stroke patients. Patients and methods. We analyzed case-series of 162 TEE performed on a total of 576 ischemic events dated between 01/01/99 to 01/05/01. The required information was collected prospectively in the Stroke Data Bank of the Neurology Department at Policlinico Bancario in Buenos Aires. Results. TEE was carried out in 162 (28.1%) cases. Of theses cases 13% belonged to the clinical subtype TACI, 37% to PACI, 17% to POCI, and 37% to LACI subtype. Pathologic findings corresponded to cardiac level: spontaneous contrast in 29% of the cases, and to aortic level: plaques grade IV in 34% and debris in 13% of the cases. According to the etiology of ischemic stroke, 67 patients had been registered under the diagnosis of lacunar infarct (60 in the anterior region and 7 in the posterior region), 93 had been diagnosed medium and grand artery infarct (73 in the anterior region and 29 in the posterior region), and 2 had remained unclassified. Emboligenic sources were found in 69.5% of TACI, 65% of PACI, 52% of POCI, and 53% of LACI. Conclusions. A high percentage of aortic artheroembolic pathology was detected in the population tinder study. However, spontaneous contrast was the echocardiographic phenomenon more frequently reported. It is to be pointed out the presence of potential cardiac and/or aortic emboligenic sources in 48% of the population with lacunar infarct.