Evaluation of right-to-left shunt on contrast-enhanced transcranial Doppler in patent foramen ovale-related cryptogenic stroke: Research based on imaging

Right-to-left shunt (RLS) can be identified by contrast-enhanced transcranial Doppler (cTCD) in patent foramen ovale (PFO) patients. AIM: To evaluate cTCD for PFO screening comparing it to cTEE. METHOD: 45 previous cTCD performed for PFO diagnosis and correlated its findings with cTEE. Patients were submitted to a cTCD standardized technique and were divided in two groups according to RLS: Group 1, patients with a positive RLS and Group 2 when RLS was negative. RESULTS: 29 (65%) patients were included in group 1 and 16 (35%) in group 2. PFO confirmation by cTEE was performed in 28 (62%) patients. cTCD had a 92.85% sensitivity, 82.35% specificity, 89.65% positive predictive value and 87.5% negative predictive value when compared to cTEE for PFO diagnosis. CONCLUSION: Standardized technique cTCD allows for RLS visualization in PFO patients with a good correlation with cTEE and can be used as a screening test before cTEE.

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Abstract WP260: Evaluation of Transcranial Doppler as a Screening Tool for High Embolic Risk Patent Foramen Ovale in Cryptogenic Stroke

Stroke ◽

10.1161/str.50.suppl_1.wp260 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Seongho Park ◽

Jin Kyung Oh ◽

Jae-Kwan Song ◽

Boseong Kwon ◽

Jong S. Kim ◽

...

Keyword(s):

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Screening Tool ◽

Cryptogenic Stroke ◽

Foramen Ovale ◽

Embolic Risk

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Transcranial Doppler as a Screening Tool for High‐Risk Patent Foramen Ovale in Cryptogenic Stroke

Journal of Neuroimaging ◽

10.1111/jon.12783 ◽

2020 ◽

Author(s):

Seongho Park ◽

Jin Kyung Oh ◽

Jae‐Kwan Song ◽

Boseong Kwon ◽

Bum Joon Kim ◽

...

Keyword(s):

High Risk ◽

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Screening Tool ◽

Cryptogenic Stroke ◽

Foramen Ovale

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Right-to-left shunt and the hypercoagulable state: does paradoxical embolism play a role in patients with antiphospholipid syndrome and stroke?

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2012000800004 ◽

2012 ◽

Vol 70 (8) ◽

pp. 578-582 ◽

Cited By ~ 2

Author(s):

Laura Nicoleti Zamproni ◽

Viviane Flumignan Zétola ◽

Marcos Christiano Lange

Keyword(s):

Antiphospholipid Syndrome ◽

Transcranial Doppler ◽

High Intensity ◽

Patent Foramen Ovale ◽

Paradoxical Embolism ◽

Foramen Ovale ◽

Contrast Enhanced ◽

Significant Difference ◽

Stroke Group ◽

History Of

OBJECTIVE: Patent foramen ovale is associated with paradoxical embolism (PE) and stroke. Hypercoagulable states, such as antiphospholipid syndrome (APS), can exacerbate PE by increasing clot formation. The aim of this study was to verify whether patients with APS and stroke present a right-to-left shunt (RLS) with greater frequency than patients with APS but without stroke. METHODS: Fifty-three patients with APS were tested for RLS using contrast-enhanced transcranial Doppler (cTCD): 23 patients had a history of stroke (Stroke Group) and 30 had no history of stroke (No-stroke Group). RESULTS: cTCD was positive in 15 patients (65%) from the Stroke Group and in 16 patients (53%) in the No-stroke Group (p=0.56). The proportion of patients with a small RLS (<10 high-intensity transient sign or HITS) and a large RLS (>10 HITS) was similar between the groups without significant difference. CONCLUSIONS: Our data do not support the theory that paradoxical embolism may play an important role in stroke in APS patients.

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Prevalence of Patent Foramen Ovale in Migraine Patients with and Without Aura Compared with Stroke Patients. A Transcranial Doppler Study

Cephalalgia ◽

10.1111/j.1468-2982.2006.01156.x ◽

2006 ◽

Vol 26 (8) ◽

pp. 934-939 ◽

Cited By ~ 54

Author(s):

FJ Carod-Artal ◽

L da Silveira Ribeiro ◽

H Braga ◽

W Kummer ◽

HM Mesquita ◽

...

Keyword(s):

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Transcranial Doppler Sonography ◽

Young Patients ◽

Data Bank ◽

Foramen Ovale ◽

Stroke Patients ◽

Doppler Study ◽

The Difference

The aim of this study was to investigate the prevalence of patent foramen ovale (PFO) in a consecutive unselected cohort of migraine patients (with and without aura) and compare it with a group of ischaemic young and elderly stroke patients. One hundred and forty-one migraine patients were compared with 330 stroke patients (130 young patients; 200 elderly patients) selected from our hospital stroke data bank. PFO was assessed with transcranial Doppler sonography with i.v. injection of agitated saline. The prevalence of PFO was 51.7± in migraine with aura (MA) patients, 33.7± in migraine without aura (MoA) patients, 33.8± in young stroke patients and 20.5± in elderly stroke patients ( P < 0.001). The prevalence of PFO in cryptogenic stroke in young and elderly stroke patients was, respectively, 41.1± and 25± ( P = 0.04). The difference between MA and MoA patients was significant (odds ratio = 2.1). The prevalence of PFO in MA patients is higher than in MoA patients and in young cryptogenic stroke patients.

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Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers

Polish Hyperbaric Research ◽

10.2478/phr-2019-0008 ◽

2019 ◽

Vol 67 (2) ◽

pp. 93-102

Author(s):

Krzysztof Dziewiatowski ◽

Piotr Siermontowski

Keyword(s):

Left Atrium ◽

Sensitivity And Specificity ◽

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Decompression Sickness ◽

Adult Population ◽

Venous Blood ◽

Arterial System ◽

Foramen Ovale ◽

Contrast Enhanced

Abstract Patent foramen ovale (PFO) is a condition present in 25% of the adult population. It is a remnant of fetal foramen ovale which allows blood to pass from the right to the left atrium, bypassing the fetal lungs. In majority adults it does not have any clinical significance, but in some people it may allow shunting of venous blood into the left atrium (right – left – shunt or RLS), circumventing the lung filter, especially during sneezing, cough, lifting heavy equipment. Is such case, PFO may be a route for venous emboli or gas bubbles from veins to the arterial system. It is known as a paradoxical embolism and may be cause of ischaemic stroke or neurologic decompression sickness (DCI), inner-ear DCI and cutis marmorata. Transesophageal echocardiography is considered as a reference standard in detection of intracardial shunts. Its sensitivity and specificity ranges between 94%-100%. However, TEE is an invasive examination with potentially serious side effects. An alternative examination in RLS detection is contrast enhanced Transcranial Doppler (the bubble study or c-TCD). In comparison to TEE, Transcranial Doppler is not invasive, relatively not expensive and save technique. With its high sensitivity and specificity in detection of PFO, 97% and 93% respectively, it may improve detection of RLS and allow to conduct screening examination for PFO in divers.

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Abstract W MP64: Evaluation of Deep Venous Thrombosis in Cryptogenic Stroke and Patent Foramen Ovale

Stroke ◽

10.1161/str.45.suppl_1.wmp64 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Ava L Liberman ◽

Vistasp Daruwalla ◽

Deborah Bergman ◽

Richard A Bernstein ◽

Yvonne Curran ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Foramen Ovale ◽

Chi Square ◽

Stroke Subtypes ◽

Contrast Enhanced ◽

Paradoxical Embolus ◽

Stroke Mechanism

Background and Purpose: In cryptogenic stroke (CS), paradoxical embolus has been suggested as a stroke mechanism. A prior study found a significant rate of pelvic deep venous thrombosis (DVT) using magnetic resonance venography (MRV). We sought to evaluate the yield of diagnostic tests for lower extremity (LE) and pelvic DVT in stroke patients with patent foramen ovale (PFO) and in the subset with CS. Methods: A single center retrospective study was performed to identify consecutive ischemic stroke or TIA patients with PFO who underwent contrast-enhanced 3D pelvic MRV imaging (Ablavar, Lantheus Medical Imaging, N. Billerica, MA) between 2009 and 2013 as part of an inpatient diagnostic evaluation. Results of pelvic MRV, LE Doppler ultrasound (US) as well as clinical data were abstracted. Ischemic subtype was retrospectively assigned using the Causative Classification System (CCS). Patients with possible cardio-aortic embolism and undetermined cause by CCS were classified as CS. We estimated point estimates and 95% confidence intervals (CI) for DVT prevalence among stroke subtypes using the Wald method and compared these using Chi-square tests. Results: Of 130 patients who met study criteria, mean age was 56 +/- 17 years and median time from admission to MRV was 2 days (IQR 1-3). Overall DVT prevalence was 7.7% (95% CI, 4.1 to 13.7); the prevalence of pelvic DVT was 1.6% (95% CI, 0.07 to 5.8) and that of LE DVT was 7.2% (95% CI, 3.7 to 13.3). Of the patients with pelvic DVT (n=2), one patient also had a LE DVT by US. When MRV or US was obtained within 72 hours following admission, the prevalence of pelvic DVT was 2.1% (95% CI, 0.12 to 7.7) and that of LE DVT was 7.8% (95% CI, 3.8 to 14.8). Comparing patients with CS (n=97) to other subtypes (n=33), there was no difference in the prevalence of pelvic DVT (2.1% vs. 0%, P=1), LE DVT (6.3% vs. 10.3%, P=0.43) or any DVT (7.2% vs. 9.1%, P=0.71). Conclusion: Patients with CS and PFO have similar prevalence of DVTs compared to other stroke subtypes. The majority of detected DVTs were in LE veins rather than pelvic veins. Only a single patient with a pelvic DVT did not have a coexistent LE DVT. Our results suggest that the utility of pelvic MRV may be much lower than previously reported.

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Current status of transcatheter closure of patent foramen ovale

Gaceta Médica de Caracas - Supplement 1 ◽

10.47307/gmc.2020.128.3.8 ◽

2020 ◽

Vol 128 (3) ◽

pp. 296-306

Author(s):

Igor F. Palacios

Keyword(s):

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Decompression Sickness ◽

Adult Population ◽

Cryptogenic Stroke ◽

Current Status ◽

Diagnostic Tools ◽

Foramen Ovale ◽

Exercise Induced ◽

Ischemic Attack

A patent foramen ovale (PFO) is a highly prevalent structure among the adult population. It allows the shunt of blood through the inter-atrial septum and has been associated with cryptogenic stroke, transient ischemic attack, significant right to left shunting resulting in resting and exercise-induced hypoxemia, platypnea orthodeoxia syndrome, and decompression sickness after scuba diving and migraines. Currently, transthoracic and transesophageal echocardiography and transcranial Doppler are the most important diagnostic tools, for the diagnosis of PFO. The sensitivity and specificity of the study depend on the modalities available: transthoracic (TTE), transesophageal (TEE), and transcranial Doppler (TCD), as well as the intravenous use of agitated saline and the site of injection.

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Paradoxical emboli: Clinical importance of transcranial doppler for detection of patent foramen ovale

Medicinski pregled ◽

10.2298/mpns1008445z ◽

2010 ◽

Vol 63 (7-8) ◽

pp. 445-449

Author(s):

Zeljko Zivanovic ◽

Svetlana Ruzicka-Kaloci ◽

Aleksandar Jesic ◽

Biljana Radovanovic ◽

Aleksandra Lucic-Prokin ◽

...

Keyword(s):

Transesophageal Echocardiography ◽

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Doppler Sonography ◽

Contrast Echocardiography ◽

Cryptogenic Stroke ◽

Transcranial Doppler Sonography ◽

Foramen Ovale ◽

Predictive Values ◽

Bubble Test

A patent foramen ovale has been reported to be more frequently detected in cryptogenic stroke, with paradoxical embolism as the major pathogenetic mechanism. The standard procedure for the detection of a patent foramen ovale is transesophageal echo?cardiography. Transcranial Doppler sonography with bubble test is almost as reliable as transesophageal echocardiography. Seventeen patients with acute ischemic stroke and transient ischemic attacks hospitalized at the Department of Neurology in Novi Sad underwent examinations to detect a patent foramen ovale, which was found in 55.6% of patients with cryptogenic stroke. The average age of these patients was 30.6 years. Transcranial Doppler sonography showed 100% sensitivity and 100% specificity for the predicti?on of right-to-left shunts proven by transesophageal contrast echocardiography. Both positive and negative predictive values in our group of patients were 1. Transcranial Doppler with bubble test is a reliable method for the detection of a patent foramen ovale, with a high level of sensitivity and specificity which is comparable with transesophageal echocardiography. Moreover, it is cheaper and more comfortable than transesophageal echocardiography, and should be used routinely in neurological practice.

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Right to left shunting detection by contrast-enhanced transcranial color-coded duplex among patients with cryptogenic stroke

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00273-9 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Samia Ashour Mohamed ◽

Mohamed Ayman Saleh ◽

Hala Mahmoud ELKhawas ◽

Eman Saleh ElHadidi ◽

Ahmed ElSadek ◽

...

Keyword(s):

Predictive Value ◽

Gold Standard ◽

Patent Foramen Ovale ◽

Recurrent Stroke ◽

Cryptogenic Stroke ◽

Foramen Ovale ◽

Stroke Patients ◽

Contrast Enhanced ◽

Ischemic Attack ◽

Sensitive Method

Abstract Background Contrast-enhanced transcranial duplex (c-TCD) might be more sensitive than transesophageal echo (TEE) for detection of right to left shunting (RLS), which misses some cases with substantial RLS and might be valuable for prediction of recurrent stroke or transient ischemic attack in patients with PFO. Our aim is to detect sensitivity and specificity of contrast-enhanced TCD in detection of RLS among stroke patients with patent foramen ovale (PFO) in comparison to TEE. Methods TEE and contrast-enhanced TCD for cryptogenic stroke patients with PFO were done to detect right to left shunting. Results On testing characteristics of TCD in detecting RLS compared to the gold standard of TEE, TCD sensitivity was 85.7%, specificity was 100%, negative predictive value was 96.55%, and positive predictive value was 100%. Conclusion We concluded that PFO is considered an important hidden etiology for ischemic stroke. Contrast-enhanced TCD is considered sensitive method for detection of right to left shunting among PFO patients.

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