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Abstract Details

Patent Foramen Ovale Detection Using Transforaminal Basilar Artery Insonation in Subjects with Acoustically Insufficient Temporal Windows
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
125

To assess the accuracy of transforaminal basilar artery insonation (TBAI) in the diagnosis of right-to-left shunt in patients with inadequate temporal windows.

40% of cryptogenic stroke (CS) patients have patent foramen ovale (PFO), compared to 20-25% of the general population. Investigation for PFO is warranted, as PFO closure in select CS patients is recommended for secondary stroke prevention. Transcranial Doppler (TCD) is non-invasive and highly sensitive for PFO detection. However, 10% of the population has insufficient temporal bone windows to allow standard TCD monitoring of the middle cerebral arteries (MCAs). Prior reports showed similar diagnostic accuracy between vertebrobasilar arteries and MCA insonation. We aimed to determine if TBAI could be used for PFO screening in individuals unable to undergo standard transtemporal insonation.
TCD with TBAI was performed in 19 patients with CS and inadequate temporal windows. All patients underwent echocardiogram with bubble, either transthoracic (TTE) or transesophageal (TEE), at the discretion of their neurologist. We assessed PFO diagnostic accuracy using TCD TBAI compared with echocardiogram.
15 females and 4 males were included (age range 31-86). All patients underwent TTE, 9 also underwent TEE. 8 subjects had PFO with both TCD and echocardiogram. 2 subjects had TCD-positive PFO, whereas echocardiogram was negative. 3 patients had PFO present on echocardiogram, whereas TCD was unrevealing. 6 subjects had absent shunt with both TCD and echocardiogram. The sensitivity of TBAI for PFO detection was 72.72%, specificity 75%, positive predictive value 80% and negative predictive value 66.67%.
In this cohort, the diagnostic accuracy of TBAI was lower compared to prior reports evaluating PFO via MCA insonation. Our limitations include small sample size and that only 47.3% of patients underwent TEE.  Future studies should compare the accuracy of TBAI for PFO diagnosis compared to TEE, which remains the gold standard for PFO characterization.
Authors/Disclosures
Nikita Chhabra, DO (Mayo Clinic)
PRESENTER 		Dr. Chhabra has nothing to disclose.
Gyanendra Kumar, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) Dr. Kumar has received personal compensation in the range of $500-$4,999 for serving as a Medical Consultant with Arizona Medical Board.
No disclosure on file
Oana M. Dumitrascu, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) Dr. Dumitrascu has nothing to disclose.