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Utility of TEE for the Evaluation of Cerebral Ischemia of Uncertain Origin-Reply

Mark Warner, MD
Arch Intern Med. 1997;157(4):461-462. doi:10.1001/archinte.1997.00440250120017.
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Stein and Marcus state that our conclusions "are inappropriately founded and are discordant with other published data." In addition, they assert that our conclusionsabout TEE not being cost-effective "are therefore misleading, as the patients studied are not representative of the patient population for which TEE is recommended." Although they raise some interesting points, I believe that their comments betray a misunderstanding of the purpose of our study.1

Stein and Marcus point out that "the American Heart Association currently recommends TEE in patients with cryptogenic stroke or transient ischemic attack." In our experience, and presently in our institution, this statement applies to the vast majority of patients with cerebral ischemia regardless of their stage in the evaluation process. In our institution, as in many others, ruling out a cardiovascular source of cerebral ischemia is the most frequent reason that a TEE examination is requested. This reflects the reality of the


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