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, Κonstantinos; Triantafyllou, Nikolaos; Chan, Bernard P.L.; Vasdekis, Spyros N.; Piperidou, Charitomeni

doi:10.1136/jnnp.2010.219733

Cited by 38 publications

(42 citation statements)

References 12 publications

(22 reference statements)

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“…TTE has no known side effects and imposes virtually no risks. Complication risk attributable to TEE was 0.2-0.5% in a study population that included patients with a heart disease, 34 a rate similar to that of gastroscopy. TEE will not be performed if any contraindication is present that is disease of upper gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 95%

Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design

Putaala

Martinez‐Majander

Saeed

et al. 2017

European Stroke Journal

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Background: Worldwide, about 1.3 million annual ischaemic strokes (IS) occur in adults aged <50 years. Of these early-onset strokes, up to 50% can be regarded as cryptogenic or associated with conditions with poorly documented causality like patent foramen ovale and coagulopathies. Key hypotheses/aims: (1) Investigate transient triggers and clinical/sub-clinical chronic risk factors associated with cryptogenic IS in the young; (2) use cardiac imaging methods exceeding state-of-the-art to reveal novel sources for embolism; (3) search for covert thrombosis and haemostasis abnormalities; (4) discover new disease pathways using next-generation sequencing and RNA gene expression studies; (5) determine patient prognosis by use of phenotypic and genetic data; and (6) adapt systems medicine approach to investigate complex risk-factor interactions. Design: Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) is a prospective multi-centre case-control study enrolling patients aged 18-49 years hospitalised due to first-ever imaging-proven IS of undetermined etiology. Patients are examined according to a standardised protocol and followed up for 10 years. Patients are 1:1 age-and sex-matched to stroke-free controls. Key study elements include centralised reading of echocardiography, electrocardiography, and neurovascular imaging, as well as blood samples for genetic, gene-expression, thrombosis and haemostasis and biomarker analysis. We aim to have 600 patientcontrol pairs enrolled by the end of 2018. Summary: SECRETO is aiming to establish novel mechanisms and prognosis of cryptogenic IS in the young and will provide new directions for therapy development for these patients. First results are anticipated in 2019.

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Section: Discussionmentioning

confidence: 95%

Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design

Putaala

Martinez‐Majander

Saeed

et al. 2017

European Stroke Journal

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“…Although rare case reports exist of cerebral vascular accidents occurring after injection of a microbubble contrast agent, these cases seem to occur only in patients with a patent foramen ovale or another right to left shunt [27][28][29]. Methods that may decrease this potential risk include holding the syringe vertically during injection (causing larger bubbles to rise) and avoiding the injection of any visible air.…”

Section: Discussionmentioning

confidence: 97%

Preferences of air-blood-saline sonographic microbubble contrast agents among emergency medicine resident physicians

Doctor

Siadecki

Rose

et al. 2015

The American Journal of Emergency Medicine

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“…24,42 Loss to follow-up was reported in 8 studies 34,36,37,40,41,[43][44][45] and could not be evaluated in 2 studies. 24,25 Only 4 studies reported no losses to follow-up after initial recruitment. 35,38,39,41 Finally, a funding source (commercial or public) was acknowledged in 3 studies.…”

Section: Risk Of Bias For Independent Studiesmentioning

confidence: 99%

“…We also included preliminary data from an ongoing cohort study conducted by our group that evaluated the risk of recurrent stroke or TIA in consecutive patients with stroke/TIA and PFO. 25 Excluding 3 duplicate studies, the remaining 345 studies were screened for eligibility criteria. Potentially eligible studies for the meta-analysis (n=21) were retained, after screening both the titles and abstracts of all studies.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

Recurrent Stroke and Patent Foramen Ovale

Katsanos

Spence

Bogiatzi

et al. 2014

Stroke

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T he frequency of patent foramen ovale (PFO) in the general population has been estimated to be 15% to 35%. 1 In patients with cryptogenic stroke, PFO is more common, but a clear causative relationship is not well established.2 Recurrent cerebrovascular events are frequent in medically treated patients with a history of paradoxical embolism 3 ; however, in more than one third of these patients concurrent pathogeneses (other than the sole presence of PFO) are identified. 4,5 Thus, it still remains unclear whether PFO is causally related to firstever or recurrent cerebral ischemia or constitutes an incidental finding of diagnostic work-up. 6,7 PFO size and the degree of functional shunting could represent potential risk factors for cerebral ischemia in medically treated patients with PFO.8 PFOs in patients with cerebral ischemia are thought to be larger 9 and to be more frequently associated with atrial septal aneurysms, compared with the PFOs in asymptomatic patients. 10 Moreover, in transcranial Doppler (TCD) studies, large PFOs were found to be significantly associated with more microembolic signals compared with small PFOs.11,12 However, data from other studies suggest that the shunt grade assessed with TCD is not associated with the brain infarct volume on computed tomography 13

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Safety of transcranial Doppler 'bubble study' for identification of right to left shunts: an international multicentre study

Abstract: TCD-BS is a safe screening test for identification of RLS, independent of the presence of cardiac structural abnormalities.

Cited by 38 publications

References 12 publications

Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design

Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design

Preferences of air-blood-saline sonographic microbubble contrast agents among emergency medicine resident physicians

Recurrent Stroke and Patent Foramen Ovale

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