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(Stroke. 2007;38:2254.)
© 2007 American Heart Association, Inc.

Original Contributions

Diagnosis of Right-to-Left Shunt With Transcranial Doppler and Vertebrobasilar Recording

Massimo Del Sette, MD; Lavinia Dinia, MD; Domenica Rizzi, MD; Annalisa Sugo, MD; Beatrice Albano, MD Carlo Gandolfo, MD

From the Department of Neurosciences, Ophthalmology, and Genetics, University of Genova, Genova, Italy.

Correspondence to Massimo Del Sette, Department of Neurosciences, Ophthalmology, and Genetics, University of Genova, Via De Toni 5, 16132 Genova, Italy. E-mail mdelsette{at}neurologia.unige.it

Background and Purpose— Right-to-left shunt (RLS) due to patent foramen ovale is a well-established risk factor for cryptogenic stroke and is highly prevalent in cases of migraine, cluster headache, and obstructive apnea. It can be diagnosed by gaseous-contrast transcranial Doppler, yet in a small percentage of cases it cannot be done owing to an insufficient temporal window. The aim of the study was to compare transtemporal with transoccipital approaches for gaseous-contrast transcranial Doppler for RLS diagnosis.

Methods— We evaluated 183 subjects with a standard protocol for RLS diagnosis by simultaneously monitoring the right middle cerebral and vertebrobasilar circulations.

Results— Vertebrobasilar recording reached high specificity (100%) and good sensitivity (83.72%) for the diagnosis of RLS after the Valsalva maneuver. For only medium and large shunts, both sensitivity and specificity reached 100%. Time to bubble appearance after injection was higher in the vertebrobasilar circulation (4.36±1.7 vs 6.77±2.5 seconds; P<0.001). There was a positive correlation between the number of bubbles in the right middle cerebral and vertebrobasilar circulation (=0.97).

Conclusions— Transcranial Doppler with vertebrobasilar monitoring is highly sensitive and specific in detecting RLS, particularly when medium or large. It can be proposed for subjects with an insufficient temporal bone window.

Key Words: middle cerebral artery • patent foramen ovale • right-to-left shunt • stroke • temporal bone window • transcranial Doppler • vertebrobasilar circulation

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				M. Del Sette, L. Dinia, and C. Gandolfo Response to Letter by Topcuoglu Stroke, August 1, 2008; 39(8): e125 - e125. [Full Text] [PDF]

				B. Vatankhah, B. Mesche, R. Korber, and H. Stolze Diagnosis of Right-to-Left Shunt: Possible Alternative Approaches Stroke, February 1, 2008; 39(2): e44 - e44. [Full Text] [PDF]