{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T20:38:38Z","timestamp":1778186318954,"version":"3.51.4"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Right to left shunt (RLS), including patent foramen ovale, is a recognized risk factor for stroke. RLS\/patent foramen ovale diagnosis is made by transthoracic echocardiography (TTE), which is insensitive, transesophageal echocardiography, which is invasive, and transcranial Doppler (TCD), which is noninvasive and accurate but scarce.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We conducted a prospective, single-arm device clinical trial of robot-assisted TCD (raTCD) versus TTE for RLS diagnosis at 6 clinical sites in patients who presented with an event suspicious for embolic cerebrovascular ischemia from October 6, 2020 to October 20, 2021. raTCD was performed with standard TCD bubble study technique. TTE bubble study was performed per local standards. The primary outcome was rate of RLS detection by raTCD versus TTE.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              A total of 154 patients were enrolled, 129 evaluable (intent to scan) and 121 subjects had complete data per protocol. In the intent to scan cohort, mean age was 60\u00b115 years, 47% were women, and all qualifying events were diagnosed as ischemic stroke or transient ischemic attack. raTCD was positive for RLS in 82 subjects (64%) and TTE was positive in 26 (20%; absolute difference 43.4% [95% CI, 35.2%\u201352.0%];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). On prespecified secondary analysis, large RLS was detected by raTCD in 35 subjects (27%) versus 13 (10%) by TTE (absolute difference 17.0% [95% CI, 11.5%\u201324.5%];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). There were no serious adverse events.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>raTCD was safe and \u22483 times more likely to diagnose RLS than TTE. TTE completely missed or underdiagnosed two thirds of large shunts diagnosed by raTCD. The raTCD device, used by health professionals with no prior TCD training, may allow providers to achieve the known sensitivity of TCD for RLS and patent foramen ovale detection without the need for an experienced operator to perform the test. Pending confirmatory studies, TCD appears to be the superior screen for RLS compared with TTE (funded by NeuraSignal).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT04604015.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.123.043380","type":"journal-article","created":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T09:00:53Z","timestamp":1696496453000},"page":"2842-2850","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Robot-Assisted Transcranial Doppler Versus Transthoracic Echocardiography for Right to Left Shunt Detection"],"prefix":"10.1161","volume":"54","clinical-trial-number":[{"clinical-trial-number":"nct04604015","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6850-7412","authenticated-orcid":true,"given":"Mark N.","family":"Rubin","sequence":"first","affiliation":[{"name":"Edward Hines, Jr. Veterans Affairs Medical Center, IL (M.N.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruchir","family":"Shah","sequence":"additional","affiliation":[{"name":"CHI Memorial Hospital, Chattanooga, TN (R.S., T.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Devlin","sequence":"additional","affiliation":[{"name":"CHI Memorial Hospital, Chattanooga, TN (R.S., T.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teddy S.","family":"Youn","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, AZ (T.S.Y., M.F.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5213-7223","authenticated-orcid":true,"given":"Michael F.","family":"Waters","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, AZ (T.S.Y., M.F.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John J.","family":"Volpi","sequence":"additional","affiliation":[{"name":"Houston Methodist Research Institute, TX (J.J.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Stayman","sequence":"additional","affiliation":[{"name":"Swedish Medical Center, Seattle, WA (A.S., C.M.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colleen M.","family":"Douville","sequence":"additional","affiliation":[{"name":"Swedish Medical Center, Seattle, WA (A.S., C.M.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ted","family":"Lowenkopf","sequence":"additional","affiliation":[{"name":"Providence Brain and Spine Institute, Portland, OR (T.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0640-3797","authenticated-orcid":true,"given":"Georgios","family":"Tsivgoulis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, \u201cAttikon\u201d University Hospital, Greece (G.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8871-1023","authenticated-orcid":true,"given":"Andrei V.","family":"Alexandrov","sequence":"additional","affiliation":[{"name":"Department of Neurology, Banner University Hospital, University of Arizona College of Medicine, Phoenix 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