Objective:

Our study, conducted between December 2021 and October 2022, aimed to assess the effectiveness of automated robotic transcranial Doppler (rTCD) as a diagnostic tool for right-left shunting (RLS) caused by patent foramen ovale (PFO) in stroke patients below 65 years old. Traditional diagnostic methods like transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have limitations, prompting our exploration of rTCD for more accurate RLS detection.

Background:

Patent foramen ovale (PFO) as a source of right-left shunting (RLS) is a recognized risk factor for recurrent stroke in young patients. Conventional techniques like TTE and TEE are limited, necessitating more sensitive methods. Previous studies suggested rTCD's higher sensitivity, prompting our retrospective analysis of its efficacy in diagnosing RLS and guiding cardiology referrals for potential PFO closure.

Design/Methods:

We evaluated 200 stroke patients below 65. All underwent standard TTE and rTCD examinations, with rTCD's performance compared to traditional methods. RLS severity was assessed via the Spencer Shunt Grading scale and analyzed by neurologists. The study aimed to identify rTCD advantages in detecting and grading RLS severity.

Results:

rTCD detected a 55.5% positive RLS shunt rate, 23.5% classified as large (Grade 3+). The no-bone window rate was significantly lower than manual TCD rates. Sensitivity comparisons revealed rTCD's superior performance, accurately identifying severe RLS cases.

Conclusions:

rTCD's replacement of TTE offered significant advantages, facilitating accurate screening, streamlined diagnosis, and precise medical management. Its heightened sensitivity identified severe RLS cases, enabling prioritized cardiology referrals and potential PFO closure. These findings underscore rTCD's potential in diagnosing RLS in stroke patients below 65, enhancing diagnostic accuracy and intervention timeliness.