[Utility of transesophageal echocardiography in young patients with cryptogenic stroke and low cardiovascular risk]. / Utilidad del ecocardiograma transesofágico en pacientes jóvenes con ictus de origen desconocido y bajo riesgo cardiovascular.

BACKGROUND AND OBJECTIVE: Stroke is a high morbimortality disease. In young patients, as many as 40% of acute strokes have no clearly identifiable cause (cryptogenic stroke) and this group of patients had until now limited therapeutic possibilities. However, transesophagical echocardiography (TEE) is changing patient management. PATIENTS AND METHOD: We studied 100 consecutive patients aged 55 years old or less with cryptogenic stroke. TEE was performed in all of them. RESULTS: TEE was normal in 49 patients while in 51 patients it showed any abnormality: patent foramen ovale (PFO) was found in 29 patients, isolated atrial septal aneurysm (ASA) in 1 patient, PFO and ASA in 12 patients, 5 patients had a cardiac mass and in 4 patients we found severe aortic atherosclerotic plaques. Therefore, TEE showed a cardiac source of stroke in 51% of patients. We changed patient management in 46 patients (90.2% of patients with abnormal TEE), indicating percutaneous treatment in 38 patients, surgery in 3 patients and anticoagulant therapy in 5 patients. CONCLUSIONS: TEE found a cardiac cause of stroke in 51% of young patients with cryptogenic stroke. These findings led to change the therapeutic management in 47% of patients. TEE seems to be a useful technique in young patients with cryptogenic stroke.

Utilidad del ecocardiograma transesofágico en pacientes jóvenes con ictus de origen desconocido y bajo riesgo cardiovascular / Utility of transesophageal echocardiography in young patients with cryptogenic stroke and low cardiovascular risk

Fundamento y objetivo: El ictus es una enfermedad de gran morbimortalidad. Hasta en un 40% de pacientes jóvenes no se llegaba a conocer la causa (ictus criptogénico) y las posibilidades terapéuticas eran escasas. Sin embargo, la ecocardiografía transesofágica (ETE) y el descubrimiento de nuevas causas de ictus están cambiando la actitud en estos pacientes. Pacientes y método: Se incluyó a 100 pacientes consecutivos de 55 años o menos ingresados en el Servicio de Neurología por ictus criptogénico a los que se les realizó ecocardiografía transtorácica y ETE. Resultados: La edad media (desviación estándar) fue 45,5 (9,7) años. La ETE fue normal en 49 pacientes y patológica en 51: foramen oval permeable (FOP) en 29 pacientes, aneurisma del septo interauricular (ASA) aislado en 1 paciente, FOP asociado a ASA en 12 pacientes, algún tipo de tumoración en 5 pacientes y ateromatosis aórtica de grado avanzado en 4 pacientes. Así, se encontró una causa de ictus en el 51% de los pacientes. Los hallazgos cambiaron la actitud clínica en 46 pacientes (90,2% de las ETE patológicas), por lo que se indicó tratamiento percutáneo en 38 pacientes, cirugía en 3 pacientes y la administración de anticoagulantes orales en 5 pacientes. Conclusiones: La ETE encontró al menos una anomalía que justificara el ictus en el 51% de los pacientes con ictus criptogénico y bajo riesgo cardiovascular. Este hallazgo produjo un cambio en la actitud clínica y terapéutica en el 90% de los pacientes con alguna alteración detectada por ETE. Esta técnica parece de utilidad para el diagnóstico y para la toma de decisiones terapéuticas en estos pacientes

Background and objective: Stroke is a high morbimortality disease. In young patients, as many as 40% of acute strokes have no clearly identifiable cause (cryptogenic stroke) and this group of patients had until now limited therapeutic possibilities. However, transesophagical echocardiography (TEE) is changing patient management. Patients and method: We studied 100 consecutive patients aged 55 years old or less with cryptogenic stroke. TEE was performed in all of them. Results: TEE was normal in 49 patients while in 51 patients it showed any abnormality: patent foramen ovale (PFO) was found in 29 patients, isolated atrial septal aneurysm (ASA) in 1 patient, PFO and ASA in 12 patients, 5 patients had a cardiac mass and in 4 patients we found severe aortic atherosclerotic plaques. Therefore, TEE showed a cardiac source of stroke in 51% of patients. We changed patient management in 46 patients (90.2% of patients with abnormal TEE), indicating percutaneous treatment in 38 patients, surgery in 3 patients and anticoagulant therapy in 5 patients. Conclusions: TEE found a cardiac cause of stroke in 51% of young patients with cryptogenic stroke. These findings led to change the therapeutic management in 47% of patients. TEE seems to be a useful technique in young patients with cryptogenic stroke