Transesophageal Echocardiography – Dysphagia Risk in Acute Stroke (TEDRAS): a prospective, blind, randomized and controlled clinical trial

Hamzic, Samra; Braun, Tobias; Butz, Marius; Khilan, H; Weber, Susanne; Yeniguen, Mesut; Gerriets, Tibo; Schramm, Patrick; Juenemann, Martin

doi:10.1111/ene.14516

Cited by 5 publications

(6 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies (11)(12)(13)) have shown that intermittent tube feeding can be used as an alternative to the traditional indwelling nasogastric tube. It is not only a way of nutritional support, but also an intervention for the treatment of dysphagia, which can improve nutritional status and swallowing function (14). However, some studies have shown that compared with continuous indwelling nasogastric tube, the effect of intermittent tube feeding in improving nutrition, swallowing function is not significant (15), so the effect of intermittent tube feeding in stroke dysphagia is still controversial.…”

Section: Original Articlementioning

confidence: 99%

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Wu¹,

Zhu²,

Zhou³

et al. 2021

Ann Palliat Med

View full text Add to dashboard Cite

Background: Nutrition supports is essential to the prognosis of stroke patients with dysphagia. It's necessary to evaluate the effects and safety of intermittent tube feeding for stroke patients with dysphagia, to provide evidence for the management of dysphagia.Methods: Cochrane Library et al. databases were searched for randomized controlled trials (RCTs) on the intermittent tube feeding for stroke patients with dysphagia up to Feb 15, 2021. Bias risk assessment tool recommended by Cochrane was used for quality assessment, and Revman5.3 software was used for data analysis.Results: A total of 11 RCTs involving 762 stroke patients with dysphagia were included. Meta-analysis indicated that intermittent tube feeding could significantly increase the rate of dysphagia function

show abstract

Section: Original Articlementioning

confidence: 99%

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Wu¹,

Zhu²,

Zhou³

et al. 2021

Ann Palliat Med

View full text Add to dashboard Cite

show abstract

“…Still, emergent cardiac CT imaging in acute stroke could be beneficial due to the direct detection of intra-cardiac thrombi in close temporal proximity to the event compared to echocardiography, which is often delayed by several days in clinical practice, and might fail to demonstrate thrombus due to thrombolytic processes 6 . Particularly TEE can frequently not be performed in acute stroke patients due to its semi-invasive nature, the need for sedation and the prevalence of relative contraindications as dysphagia 17 .…”

Section: Discussionmentioning

confidence: 99%

Spectral cardiac CT in acute stroke patients

Larsen

Austein

Klintz

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Cardiac CT obtained in acute ischemic stroke patients can facilitate timely detection of cardiac sources of embolism and guide secondary prevention strategies. Spectral CT exploiting the simultaneous acquisition of separate higher-energy and lower-energy photon spectrum datasets has the potential to improve contrast between thrombi and cardiac structures. This study aimed to investigate the diagnostic value of spectral cardiac CT compared to conventional CT for the detection of cardiac thrombi in acute stroke patients. Patients with acute ischemic stroke undergoing spectral cardiac CT were retrospectively included. Conventional CT images, virtual 55 keV monoenergetic (monoE55), z-effective (zeff), and iodine density images were evaluated for the presence of thrombi. Diagnostic certainty was rated on a 5-point Likert scale. Contrast ratios were calculated for all reconstructions. 63 patients with 20 thrombi were included. Four thrombi were missed on conventional images but detected on spectral reconstructions. MonoE55 achieved the highest scores for diagnostic certainty. Contrast ratios were highest on iodine density images, followed by monoE55, conventional and zeff (p < 0.005). Spectral cardiac CT adds diagnostic benefit for the detection of intra-cardiac thrombi in acute ischemic stroke patients compared to conventional CT.

show abstract

“…6,14 Transesophageal echocardiogram (TEE), which offers gold standard visualization of the LA/LAA, is invasive, not widely available due to resource constraints, 14,15 and may exacerbate dysphagia in stroke patients. 16 Cardiac CT angiography (cCTA) is a potential alternative imaging modality to assess cardiac structures and address some of the limitations of echocardiogram. ECGgated cCTA has been investigated for the detection of LA/ LAA thrombus, showing comparable sensitivity and specificity to TEE, but may be challenging to practically implement in the hyperacute setting.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non–ECG-gated cardiac CT angiography in acute stroke is feasible and detects sources of embolism

Lee

Dhillon

Pourafkari

et al. 2023

International Journal of Stroke

View full text Add to dashboard Cite

Background: A significant portion of cryptogenic stroke is hypothesized to be secondary to cardiac embolism. However, transthoracic echocardiogram is usually delayed after stroke and more detailed cardiac imaging not routinely done. Aims: This study aimed to determine whether non-ECG gated cardiac CT angiography (cCTA) during hyperacute stroke would provide diagnostic quality images and act as an adjunct modality of cardiac imaging to detect sources of emboli. Methods: In this single-centre prospective cohort study, modified Code Stroke imaging was implemented with a 64-slice CT scanner, where the longitudinal axis of CT angiography was extended from the carina to the diaphragm. Primary outcome of image quality, recruitment feasibility, impact on hyperacute time metrics and additional radiation dose were assessed. Secondary outcomes consisted of detection of high-risk cardiac sources of embolism, mediastinal or lung pathology and impact on etiologic classification. Results: One hundred and twenty eligible patients were enrolled, of which 105 (87.5%) had good/moderate quality images for motion artifact and 119 (99.2%) for contrast opacification. Total CT-time, door-to-needle time and door-to-groin puncture time were unchanged with the addition of cCTA. Eighty-nine patients received a final diagnosis of ischemic stroke, of which 12/89 (13.5%) had high-risk cardioembolic findings on cCTA. Incidental findings, such as pulmonary embolism (7/89, 7.9%) and malignancy (6/89, 6.7%), were observed. cCTA led to changes in management for 19/120 (15.8%) of all patients, and reclassification of stroke etiology for 8/89 (9%) of patients. Conclusions: Non- ECG-gated cCTA can be feasibly incorporated into Code Stroke and provide diagnostic quality images without delays in hyperacute time metrics. It can detect high-risk cardiac sources, and other findings impacting patient care. This may help reclassify a subset of cryptogenic stroke cases and improve secondary prevention. Data Availability: Data from this study is available and can be accessed upon request.

show abstract

Transesophageal Echocardiography – Dysphagia Risk in Acute Stroke (TEDRAS): a prospective, blind, randomized and controlled clinical trial

Cited by 5 publications

References 28 publications

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Spectral cardiac CT in acute stroke patients

Non–ECG-gated cardiac CT angiography in acute stroke is feasible and detects sources of embolism

Contact Info

Product

Resources

About