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. 2020 Dec 3;15(12):e0243142.
doi: 10.1371/journal.pone.0243142. eCollection 2020.

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

Polina Specktor  1   2 , Sergey Yalonetsky  1 , Yoram Agmon  1 , Elliot Sprecher  1 , Faten Haj Ali  1 , Gregory Telman  1   3
Affiliations

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

Polina Specktor et al. PLoS One. .

Abstract

Background and purpose: 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.

Methods: Retrospective data on patients with AIS or TIA who underwent TEE examination between 2000-2013 were collected from the institutional registry.

Results: 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).

Conclusions: 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Characteristics of aortic atheromas.
TEE- transesophageal echocardiography; Small atheroma- 4 mm thick plaques and less; Large atheroma- plaques thicker than 4 mm; Complex atheroma- plaques that are ulcerated or with mobile debris, regardless of their size.
Fig 2
Fig 2. Contingency analysis of corrected reason for treatment change (collapsed) by age groups.
Significant TEE finding- tumor, thrombus or endocarditis; PFO- patent foramen ovale (25 cases with shunt, one case without shunt); plaques- 53 complex, 13 large, 5 small; Hf- severe heart failure.
Fig 3
Fig 3. Temporal distribution of treatment changes due to TEE findings in patients who underwent TEE (descriptive statistics, no statistical significance).
TEE- transesophageal echocardiography.
See this image and copyright information in PMC

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