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

Abstract

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.

Keywords

• Right to left shunting
• Cryptogenic stroke
• Contrast-enhanced transcranial duplex
• Transesophageal echo
• Patent foramen ovale