Abstract WP169: The Utility Of Transesophageal Echocardiogram In Embolic Strokes Of Undetermined Source Not Associated With Patent Foramen Ovale

Introduction: Transesophageal echocardiography (TEE) is frequently utilized in the diagnosis of embolic stroke of undetermined significance (ESUS), with a patent foramen ovale (PFO) being the most common finding. Transcranial doppler (TCD) is comparable to TEE in diagnosing a right-to-left shunt, while being less invasive. Our aim is to evaluate the diagnostic yield of TEE excluding the diagnosis of PFO, in patients with ischemic stroke satisfying ESUS criteria. Methods: We retrospectively evaluated patients at our institution with acute ischemic stroke fulfilling ESUS criteria who underwent TEE examination during a 50-month period (May 2017 to July 2021). In these patients, we also evaluated whether TCD bubble study was done. We assessed whether non-PFO TEE findings altered management course. Results: We identified 113 patients with ESUS who underwent investigation with TEE (mean age 65 ± 13.5 years, 62% men, 38% women, median NIH Stroke Scale = 4 points [interquartile range: 2-9]). TEE revealed a PFO in 23.4% (95% CI: 19%-28.8%). TCD was performed in 55.6% of the patients with a PFO found on TEE, and revealed a right-to-left shunt in 80% of them. Excluding the finding of PFO, TEE revealed additional findings in 27 (23.9% [95% CI: 15.9%-31.2%]) patients. This changed management (anticoagulation therapy or surgical evaluation) in 3 (2.7% [95% CI: 0%-5.6%]) patients. The surgical evaluation was due to marantic valve endocarditis. No patients required IV antibiotic therapy due to TEE findings. Conclusions: Abnormal TEE findings only rarely affect the management in ESUS. TCD may be sufficient to screen for PFO in ESUS patients.