The role of transesophageal echocardiography in the diagnosis of ischemic stroke in the elderly

Cardioembolic stroke is quite common (15% of all ischemic strokes) not only in younger patients but also in the elderly. Clinical diagnosis is often difficult. Transthoracic echocardiography (TTE) seems to be the most reliable non-invasive method of examination. Because of the close topographical relationship between heart and esophagus, transesophageal echocardiography (TEE) is particularly suitable to evaluate those cardiac structures (left atrium and appendage) where the embolus can most likely be found. Using TTE and TEE, we studied 62 patients older than 65 years of age (mean age 76 ± 6), having been affected by ischemic stroke. TEE proved to be clearly superior to TTE in the diagnosis of cardioembolic stroke, without any major complication during the execution of this diagnostic method.