{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T09:18:09Z","timestamp":1773047889645,"version":"3.50.1"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T00:00:00Z","timestamp":1738800000000},"content-version":"vor","delay-in-days":36,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neuroimaging"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Purpose<\/jats:title>\n                    <jats:p>Right\u2010to\u2010left shunt (RLS), usually related to a patent foramen ovale (PFO), is an important cause of cryptogenic stroke (CS) in young patients. Transcranial Doppler (TCD) with an agitated saline bubble study is a highly sensitive modality for RLS diagnosis using a transtemporal approach (TTD). However, a minority of patients have insufficient temporal bone windows. We aimed to evaluate the accuracy of transforaminal TCD (TFD) for RLS diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included patients with CS or transient ischemic attack who were tested in the standard protocol for RLS between March 2022 and February 2023. We evaluated the concordance of RLS grades between TFD and transesophageal echocardiogram (TEE) using the weighted kappa index. We also compared TTD and TFD approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty patients were included (66.7% men; median age 49 years). Medium or large RLS were found in 28 patients (70%) with TTD and in 27 patients with TFD (67.5%). Through TEE, 19 (82.6%) medium or large PFO were confirmed, and a high agreement rate of 0.684 (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0003) was observed for grading RLS. Moreover, the agreement rate of RLS grade between TTD and TFD was 0.73 (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TFD is a valid approach for RLS diagnosis, with substantial concordance with TEE in grading RLS. Our study found a good grade of agreement between TFD and TEE. Therefore, the value of TCD goes beyond quantifying RLS and could assist in identifying the patients with the largest RLS, who would gain the greatest benefit from PFO closure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jon.70023","type":"journal-article","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T06:54:44Z","timestamp":1738824884000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Grading Right\u2010to\u2010Left Shunt With Transforaminal Doppler: A Valid Approach in Patients With Cryptogenic Stroke"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3450-7461","authenticated-orcid":false,"given":"Beatriz","family":"Mart\u00ednez Garc\u00eda","sequence":"first","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Luis","family":"Chico Garc\u00eda","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"P\u00e9rez Gil","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Garay Alb\u00edzuri","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Llanes Ferrer","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Garc\u00eda Alc\u00e1ntara","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"Caba\u00f1as Engenios","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Consuelo","family":"Matute Lozano","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia","family":"De Felipe Mimbrera","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roc\u00edo","family":"Vera Lechuga","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Cruz Culebras","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Carri\u00f3n S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Cardiology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Covadonga","family":"Fern\u00e1ndez\u2010Golf\u00edn","sequence":"additional","affiliation":[{"name":"Department of Cardiology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaime","family":"Masjuan","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"},{"name":"Faculty of Medicine and Health Sciences Universidad de Alcal\u00e1  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebasti\u00e1n","family":"Garc\u00eda Madrona","sequence":"additional","affiliation":[{"name":"Stroke Comprehensive Center, Department of Neurology Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria, Hospital Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2020-063161","article-title":"Advances in the Management of Cardioembolic Stroke Associated With Patent Foramen Ovale","volume":"376","author":"Mac Grory B.","year":"2022","journal-title":"BMJ"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.018153"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-5629(97)00077-X"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6569.2003.tb00198.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/01616412.2018.1428276"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jon.12311"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep24932"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.106.479485"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000016119"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2008.12.001"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jon.12855"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24609"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2015.05.015"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.040546"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.043380"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-10645-7"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6569.2004.tb00261.x"}],"container-title":["Journal of Neuroimaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jon.70023","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jon.70023","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jon.70023","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T08:22:27Z","timestamp":1773044547000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jon.70023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/jon.70023"],"URL":"https:\/\/doi.org\/10.1111\/jon.70023","archive":["Portico"],"relation":{},"ISSN":["1051-2284","1552-6569"],"issn-type":[{"value":"1051-2284","type":"print"},{"value":"1552-6569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2024-12-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70023"}}