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Abstract Details

Utility of Transesophageal Echocardiography in the Identification and Treatment of Occult Mechanisms of Cerebral Infarction
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
136
To evaluate the diagnostic utility of TEE in identifying cardiac sources of embolism (CSE) in cryptogenic stroke patients and to determine whether the identification of these CSE results in clinically significant management changes.
Cryptogenic stroke comprises approximately 25% of all cases of ischemic stroke. The diagnostic evaluation of these patients remains a challenge in clinical practice. Transesophageal echocardiography (TEE) has been shown to have superior diagnostic accuracy in identifying potential cardioembolic sources of ischemic stroke when compared to transthoracic echocardiography (TTE).
A prospective registry of consecutively admitted patients with acute ischemic stroke (1/1/2015-8/10/2020) was retrospectively queried. Patients 18 to 60 years of age with stroke due to mechanisms other than large or small vessel disease, or atrial fibrillation were eligible for inclusion. The primary outcome was any high-risk CSE identified on TEE following unrevealing TTE. Secondary outcomes included a composite of individual CSEs and subsequent management changes.  
Of the 2,404 consecutive stroke patients evaluated during the study period, 263 (11%) met inclusion criteria; 103 (39%) were women and the median age was 53 (IQR 46-57). TEE was ordered in 133 patients (51%) and performed in 108 patients (81% of those with orders). A high-risk CSE was identified in 36 patients (33%), the majority of which were PFOs (n=29). TEE led to a clinical management change in 14 patients (39%) after identification of a high-risk CSE. 
In our single-center study of cryptogenic stroke patients, the addition of TEE to the comprehensive stroke evaluation led to the identification of a high-risk CSE in one in three patients resulting in significant management changes. Most high-risk CSEs were PFOs, which likely underestimates the likelihood of management change given the publication of successful PFO closure trials in the middle of our study period.
Authors/Disclosures

PRESENTER 		No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Ameena Rana, MD (Mount Sinai Health System) Dr. Rana has nothing to disclose.
No disclosure on file
No disclosure on file
Jesse Thon, MD (Cooper University Hospital) An immediate family member of Dr. Thon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech.
James E. Siegler III, MD (University of Chicago) Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siegler has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Serb. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Wallaby Phenox. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke: Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Precision Medicine, LLC. The institution of Dr. Siegler has received research support from Philips. The institution of Dr. Siegler has received research support from Medtronic.