The Need to Quantify Right-to-Left Shunt in Acute Ischemic Stroke
- 1 July 1998
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 29 (7), 1322-1328
- https://doi.org/10.1161/01.str.29.7.1322
Abstract
Background and Purpose —Although right-to-left shunt (RLSh) has been reported to be significantly more frequent in young stroke patients with cryptogenic stroke, its relevance in a nonselected population of acute ischemic stroke is not well known. The aim of this study was to determine the importance of the RLSh magnitude as a risk factor for stroke in nonselected patients. Methods —Two hundred eight patients hospitalized consecutively with transient ischemic attack or acute cerebral infarction and 100 healthy control subjects were studied. Transcranial Doppler ultrasonography (TCD) was performed in both middle cerebral arteries (MCAs) after intravenous application of agitated saline solution. The magnitude of RLSh was quantified by counting the number of signals in 1 MCA during a Valsalva maneuver. RLSh was classified as “no shunt,” “small” (10 signals), with the latter including the “shower” (>25 signals) and “curtain” (uncountable signals) patterns. Extensive investigations, including contrast transesophageal echocardiography, were carried out on patients diagnosed as suffering from stroke of an uncertain etiology. The importance of RLSh for stroke was assessed by logistic regression analysis. Results —Contrast TCD detected a large RLSh in 40 (19.7%) patients and in 21 (21%) control subjects, all with cardiac RLSh characteristics. A large RLSh was present in 4.7% of atherothrombotic strokes, 10.5% of cardioembolic strokes, 15.4% of lacunar strokes, and 45.3% of cryptogenic strokes ( P Conclusions —It is essential to quantify RLSh by contrast TCD during the Valsalva maneuver given that only those with shower and curtain patterns are associated with a higher risk of ischemic stroke in a nonselected population.This publication has 30 references indexed in Scilit:
- Recurrent cerebrovascular events in patients with patent foramen ovale, atrial septal aneurysm, or both and cryptogenic stroke or transient ischemic attackAmerican Heart Journal, 1995
- Evidence that patent foramen ovale is not a risk factor for cerebral ischemia in the elderlyThe American Journal of Cardiology, 1994
- Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patientsThe American Journal of Cardiology, 1994
- EditorialThe International Journal of Cardiovascular Imaging, 1993
- Diagnosis of patent foramen ovale by transesophageal echocardiography and association with cerebral and peripheral embolic eventsThe American Journal of Cardiology, 1992
- Risk of patent foramen ovale for thromboembolic events in all age groupsThe American Journal of Cardiology, 1992
- Detection of patent foramen ovale by transcranial contrast Doppler ultrasoundThe American Journal of Cardiology, 1992
- Comparison of transcranial Doppler ultrasound and transesophageal contrast echocardiography in the detection of interatrial right-to-left shuntsThe American Journal of Cardiology, 1991
- Prevalence of Patent Foramen Ovale in Patients with StrokeThe New England Journal of Medicine, 1988
- Detection of spontaneous echocardiographic contrast within the left atrium by transesophageal echocardiography: spontaneous echocardiographic contrastClinical Cardiology, 1986