Reza Bavarsad Shahripour: A Practical Multimodal, Center-Specific Approach for Right-to-Left Shunt Detection in ESUS
Reza Bavarsad Shahripour, Associate Editor at Clinical Neuroimaging Journal, shared a post on LinkedIn about a recent article he and his colleagues co-authored, adding:
”Excited to share our recent work on comparing TCD, TTE, TEE, and cardiac CT in detecting right-to-left shunt in patients with ESUS.
Key takeaways:
- TCD is a highly sensitive, noninvasive tool – ideal for initial screening
- TEE provides the most reliable anatomical detail when confirmation is needed
- TTE remains a practical and widely available option
- Cardiac CT can be helpful in select cases but is not ideal as a standalone test
Overall, a stepwise, multimodal approach works best—starting with a sensitive screening tool and following with targeted confirmatory imaging.
Practical teaching point:
Instead of asking ‘which test is best?’, ask:
‘Which test works best in our center?’
The performance of these modalities depends heavily on local expertise, protocols, and workflow.
A strong neurosonology lab: TCD-first makes sense
Limited TCD access: TTE-first may be more practical
Complex cases: early TEE
The goal is to build a center-specific pathway that is efficient, reliable, and reproducible—not a one-size-fits-all algorithm.
Grateful to collaborate with an amazing team at UCSD and beyond.”
Title: Comparative Accuracy of TCD, TTE, TEE, and Cardiac CT in Detecting Right-to-Left Shunt in Embolic Stroke of Undetermined Source
Authors: Vikas Ravi, Yasaman Pirahanchi, Seyed Behnam Jazayeri, Emma Rice, Dawn Meyer, Kunal Agrawal, Royya Modir, Thomas Hemmen, Brett Meyer, Reza Bavarsad Shahripour
Read the Full Article on Neurology Clinical Practice
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