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Reza Bavarsad Shahripour: A Practical Multimodal, Center-Specific Approach for Right-to-Left Shunt Detection in ESUS
Reza Bavarsad Shahripour/LinkedIn
Mar 28, 2026, 15:45

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

Reza Bavarsad Shahripour: A Practical Multimodal, Center-Specific Approach for Right-to-Left Shunt Detection in ESUS

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Brett Meyer Dawn Meyer Emma Rice ESUS Health Hematology Hemostasis Hemostasis News Hemostasis Today Kunal Agrawal Medicine Reza Bavarsad Shahripour Royya Modir Seyed Behnam Jazayeri shunt stroke Thomas Hemmen thrombosis Vikas Ravi Yasaman Pirahanchi
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