Right to left shunt (RLS), including patent foramen ovale (PFO), is a known risk factor for stroke. Diagnosing RLS or PFO can be done using transthoracic echocardiography (TTE) or transcranial Doppler (TCD). A recent multicenter study, known as BUBL, tested a new method using robot-assisted TCD (raTCD). The study found that raTCD was significantly more effective in detecting RLS compared to TTE, with raTCD detecting RLS in 64% of cases versus 20% with TTE.

To determine if these results are applicable in everyday clinical settings, researchers conducted a multi-site retrospective review of clinical data from patients who underwent raTCD. This review included 350 patients across three participating sites.

Real-World Validation of raTCD for RLS Detection

The clinical data showed that raTCD detected RLS in 54% of cases, which was not significantly different from the 64% detection rate in the initial study. Additionally, large RLS was found in 26% of cases in the clinical setting, closely matching the initial study’s 28%.

The study concluded that raTCD is effective in clinical practice, maintaining high sensitivity for detecting RLS and PFO without needing a highly experienced operator. These results support the use of raTCD as a reliable method for RLS and PFO detection in a real-world clinical setting, potentially improving stroke prevention strategies.