Safety of transcranial doppler 'bubble study' for identification of right to left shunts

An international multicentre study

Georgios Tsivgoulis, Elefterios Stamboulis, Vijay K. Sharma, Ioannis Heliopoulos, Konstantinos Voumvourakis, Hock Luen Teoh, Konstantinos Vadikolias, Nikos Triantafyllou, Bernard P.L. Chan, Spyros N. Vasdekis, Charitomeni Piperidou

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background and purpose: A recent retrospective study using an online list service established by the American Academy of Neurology has suggested that ischaemic cerebrovascular events may occur in patients who undergo 'bubble studies' (BS) with either transcranial Doppler (TCD) or transoesophageal echocardiography (TOE). The safety of TCD-BS for right to left shunt (RLS) identification was evaluated prospectively in an international multicentre study. Methods: Consecutive patients with cerebral ischaemia (ischaemic stroke or transient ischaemic attack (TIA)) were screened for potential ischaemic cerebrovascular events following injection of microbubbles during TCD-BS for identification of RLS at three tertiary care stroke centres. TCD-BS was performed according to the standardised International Consensus Protocol. TOE-BS was performed in selected cases for confirmation of TCD-BS. Results: 508 patients hospitalised with acute cerebral ischaemia (mean age 46±12 years, 59% men; 63% ischaemic stroke, 37% TIA) were investigated with TCDBS within 1 week of ictus. RLS was identified in 151 cases (30%). TOE-BS was performed in 101 out of 151 patients with RLS identified on TCD-BS (67%). It was positive in 99 patients (98%). The rate of ischaemic cerebrovascular complications during or after TCD-BS was 0% (95% CI by the adjusted Wald method: 0-0.6%). Structural cardiac abnormalities were identified in 38 patients, including atrial septal aneurysm (n=23), tetralogy of Fallot (n=1), intracardiac thrombus (n=2), ventricular septal defect (n=3) and atrial myxoma (n=1). Conclusion: TCD-BS is a safe screening test for identification of RLS, independent of the presence of cardiac structural abnormalities.

Original languageEnglish (US)
Pages (from-to)1206-1208
Number of pages3
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume82
Issue number11
DOIs
StatePublished - Nov 1 2011

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Multicenter Studies
Transesophageal Echocardiography
Safety
Stroke
Transient Ischemic Attack
Brain Ischemia
Microbubbles
Myxoma
Tetralogy of Fallot
Doppler Echocardiography
Ventricular Heart Septal Defects
Patient Rights
Tertiary Care Centers
Aneurysm
Thrombosis
Retrospective Studies
Injections

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Safety of transcranial doppler 'bubble study' for identification of right to left shunts : An international multicentre study. / Tsivgoulis, Georgios; Stamboulis, Elefterios; Sharma, Vijay K.; Heliopoulos, Ioannis; Voumvourakis, Konstantinos; Teoh, Hock Luen; Vadikolias, Konstantinos; Triantafyllou, Nikos; Chan, Bernard P.L.; Vasdekis, Spyros N.; Piperidou, Charitomeni.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 82, No. 11, 01.11.2011, p. 1206-1208.

Research output: Contribution to journalArticle

Tsivgoulis, G, Stamboulis, E, Sharma, VK, Heliopoulos, I, Voumvourakis, K, Teoh, HL, Vadikolias, K, Triantafyllou, N, Chan, BPL, Vasdekis, SN & Piperidou, C 2011, 'Safety of transcranial doppler 'bubble study' for identification of right to left shunts: An international multicentre study', Journal of Neurology, Neurosurgery and Psychiatry, vol. 82, no. 11, pp. 1206-1208. https://doi.org/10.1136/jnnp.2010.219733
Tsivgoulis, Georgios ; Stamboulis, Elefterios ; Sharma, Vijay K. ; Heliopoulos, Ioannis ; Voumvourakis, Konstantinos ; Teoh, Hock Luen ; Vadikolias, Konstantinos ; Triantafyllou, Nikos ; Chan, Bernard P.L. ; Vasdekis, Spyros N. ; Piperidou, Charitomeni. / Safety of transcranial doppler 'bubble study' for identification of right to left shunts : An international multicentre study. In: Journal of Neurology, Neurosurgery and Psychiatry. 2011 ; Vol. 82, No. 11. pp. 1206-1208.
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abstract = "Background and purpose: A recent retrospective study using an online list service established by the American Academy of Neurology has suggested that ischaemic cerebrovascular events may occur in patients who undergo 'bubble studies' (BS) with either transcranial Doppler (TCD) or transoesophageal echocardiography (TOE). The safety of TCD-BS for right to left shunt (RLS) identification was evaluated prospectively in an international multicentre study. Methods: Consecutive patients with cerebral ischaemia (ischaemic stroke or transient ischaemic attack (TIA)) were screened for potential ischaemic cerebrovascular events following injection of microbubbles during TCD-BS for identification of RLS at three tertiary care stroke centres. TCD-BS was performed according to the standardised International Consensus Protocol. TOE-BS was performed in selected cases for confirmation of TCD-BS. Results: 508 patients hospitalised with acute cerebral ischaemia (mean age 46±12 years, 59{\%} men; 63{\%} ischaemic stroke, 37{\%} TIA) were investigated with TCDBS within 1 week of ictus. RLS was identified in 151 cases (30{\%}). TOE-BS was performed in 101 out of 151 patients with RLS identified on TCD-BS (67{\%}). It was positive in 99 patients (98{\%}). The rate of ischaemic cerebrovascular complications during or after TCD-BS was 0{\%} (95{\%} CI by the adjusted Wald method: 0-0.6{\%}). Structural cardiac abnormalities were identified in 38 patients, including atrial septal aneurysm (n=23), tetralogy of Fallot (n=1), intracardiac thrombus (n=2), ventricular septal defect (n=3) and atrial myxoma (n=1). Conclusion: TCD-BS is a safe screening test for identification of RLS, independent of the presence of cardiac structural abnormalities.",
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AU - Stamboulis, Elefterios

AU - Sharma, Vijay K.

AU - Heliopoulos, Ioannis

AU - Voumvourakis, Konstantinos

AU - Teoh, Hock Luen

AU - Vadikolias, Konstantinos

AU - Triantafyllou, Nikos

AU - Chan, Bernard P.L.

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