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

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 82; no. 11; pp. 1206 - 1208
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.11.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Biological and medical sciences; Cerebrovascular Circulation; Echocardiography, Transesophageal - methods; Embolisms; Female; Heart Septal Defects, Atrial - diagnosis; Heart Septal Defects, Atrial - diagnostic imaging; Humans; Hypotheses; Investigative techniques, diagnostic techniques (general aspects); Ischemia; Ischemia - diagnosis; Ischemia - diagnostic imaging; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - diagnostic imaging; Male; Medical sciences; Microbubbles; Middle Aged; Nervous system; Neurology; Patient Safety; Patients; Prospective Studies; Radionuclide investigations; Stroke; Stroke - diagnosis; Stroke - diagnostic imaging; Transient ischemic attack; Ultrasonic investigative techniques; Ultrasonography, Doppler, Transcranial - methods; Vascular diseases and vascular malformations of the nervous system; United States > US; Sonography; Doppler ultrasound study; Bubble; Nervous system diseases; Right to left shunt; Cardiovascular disease; Safety; Left to right shunt
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2010.219733

Background and purposeA 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.MethodsConsecutive 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.Results508 patients hospitalised with acute cerebral ischaemia (mean age 46±12 years, 59% men; 63% ischaemic stroke, 37% TIA) were investigated with TCD-BS 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).ConclusionTCD-BS is a safe screening test for identification of RLS, independent of the presence of cardiac structural abnormalities.