The effect of TEE on treatment change in patients with acute ischemic stroke

Ischemic stroke is a widespread disease carrying high morbidity and mortality. Transesophageal echocardiography (TEE) is considered an important tool in the work-up of patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients; its utility is limited by a semi-invasive na...

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Bibliographic Details
Published in:	PloS one Vol. 15; no. 12; p. e0243142
Main Authors:	Specktor, Polina, Yalonetsky, Sergey, Agmon, Yoram, Sprecher, Elliot, Ali, Faten Haj, Telman, Gregory
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 03-12-2020 Public Library of Science (PLoS)
Subjects:	Aged Angina pectoris Anticoagulants Anticoagulants - therapeutic use Aorta Aorta - drug effects Aorta - pathology Cardiac arrhythmia Care and treatment Cholesterol Coronary vessels Diabetes Disease Echocardiography Echocardiography, Transesophageal Endocarditis Etiology Female Hospitalization Humans Hypertension Ischemia Ischemic Stroke - diagnosis Ischemic Stroke - drug therapy Male Medicine and Health Sciences Middle Aged Morbidity Neurology Patient outcomes Plaques Research and Analysis Methods Retrospective Studies Risk factors Stroke Thrombosis Transient ischemic attack Israel
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Summary:	Ischemic stroke is a widespread disease carrying high morbidity and mortality. Transesophageal echocardiography (TEE) is considered an important tool in the work-up of patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients; its utility is limited by a semi-invasive nature. The purpose of this study was to evaluate the probability of treatment change due to TEE findings (yield) in the work-up of AIS and TIA patients. Retrospective data on patients with AIS or TIA who underwent TEE examination between 2000-2013 were collected from the institutional registry. The average age of 1284 patients who were included in the study was 57±10.4, 66% of patients were male. The most frequent TEE findings included aortic plaques in 54% and patent foramen ovale (PFO) in 15%. TEE findings led to treatment change in 135 (10.5%) patients; anticoagulant treatment was initiated in 110 of them (81%). Most common etiology for switch to anticoagulation was aortic plaques (71 patients); PFO was second most common reason (26 patients). Significant TEE findings (thrombus, endocarditis, tumor) were found in 1.9% of patients, they were more common in young patients (<55; 56% of the patients). The beginning of anticoagulation treatment in patients with thick and complicated plaques was found frequently in our study. Significant TEE findings, were infrequent, constituted an absolute indication for treatment change and were more common in younger patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0243142