ABSTRACT
Background and Purpose
Right-to-left shunt (RLS), usually related to a patent foramen ovale (PFO), is an important cause of cryptogenic stroke (CS) in young patients. Transcranial Doppler (TCD) with an agitated saline bubble study is a highly sensitive modality for RLS diagnosis using a transtemporal approach (TTD). However, a minority of patients have insufficient temporal bone windows. We aimed to evaluate the accuracy of transforaminal TCD (TFD) for RLS diagnosis.
Methods
We included patients with CS or transient ischemic attack who were tested in the standard protocol for RLS between March 2022 and February 2023. We evaluated the concordance of RLS grades between TFD and transesophageal echocardiogram (TEE) using the weighted kappa index. We also compared TTD and TFD approaches.
Results
Forty patients were included (66.7% men; median age 49 years). Medium or large RLS were found in 28 patients (70%) with TTD and in 27 patients with TFD (67.5%). Through TEE, 19 (82.6%) medium or large PFO were confirmed, and a high agreement rate of 0.684 (p = 0.0003) was observed for grading RLS. Moreover, the agreement rate of RLS grade between TTD and TFD was 0.73 (p < 0.0001).
Conclusion
TFD is a valid approach for RLS diagnosis, with substantial concordance with TEE in grading RLS. Our study found a good grade of agreement between TFD and TEE. Therefore, the value of TCD goes beyond quantifying RLS and could assist in identifying the patients with the largest RLS, who would gain the greatest benefit from PFO closure.
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This post is Copyright: Beatriz Martínez García,
Juan Luis Chico García,
Daniel Pérez Gil,
Patricia Garay Albízuri,
Ana Llanes Ferrer,
Gabriel García Alcántara,
Gloria Cabañas Engenios,
María Consuelo Matute Lozano,
Alicia De Felipe Mimbrera,
Rocío Vera Lechuga,
Antonio Cruz Culebras,
Irene Carrión Sánchez,
Covadonga Fernández‐Golfín,
Jaime Masjuan,
Sebastián García Madrona | February 6, 2025
Wiley: Journal of Neuroimaging: Table of Contents