Transesophageal echocardiography for evaluating acute ischemic stroke of unknown cause remains debated due to trade-offs between superior detection of embolic sources and increased cost and risk.
Does transesophageal echocardiography improve the detection of cardiac sources of embolism compared to routine evaluation in patients with acute ischemic stroke of unknown cause?
The text highlights the ongoing debate regarding the routine use of transesophageal echocardiography in patients with cryptogenic stroke or ESUS to detect occult cardiac sources of embolism.
For more than 25 years, neurologists and cardiologists have debated the role of transesophageal echocardiography (TEE) in the evaluation of patients with acute ischemic stroke (AIS) of unknown cause. Approximately 1 in 4 stroke patients do not have a specific cause elucidated by routine inpatient evaluations, and mounting data suggest that many of these patients have occult cardiac sources of embolism (CSE). Recently, the new classification of embolic stroke of undetermined source (ESUS) has been proposed to define the subset of patients in whom there is suspicion, but not proof of, a CSE.1 TEE, however, is not required for a diagnosis of ESUS. Proponents of routine use of TEE in patients with cryptogenic stroke or ESUS note its superiority to transthoracic echocardiography in detection of CSE2 and the higher morbidity and mortality associated with strokes of cardiac cause.3 In contrast, detractors point to increased cost and risk with a relatively low yield of management-changing findings.
Eckerle et al. (Thu,) conducted a editorial in Acute ischemic stroke of unknown cause / Embolic stroke of undetermined source (ESUS). Transesophageal echocardiography (TEE) vs. Transthoracic echocardiography was evaluated. Transesophageal echocardiography for evaluating acute ischemic stroke of unknown cause remains debated due to trade-offs between superior detection of embolic sources and increased cost and risk.