Trial Procedures
RLS
Enrolled patients underwent raTCD (NovaGuide Intelligent Ultrasound, NeuraSignal Inc, Los Angeles, CA) in addition to standard of care TTE with agitated saline contrast bubble study, both within 30 days of informed consent. The raTCD is a five-degree-of-freedom robotic unit paired with a signal optimization algorithm that supports traditional 2 MHz diagnostic TCD. Any other diagnostics for RLS testing (eg, TEE or TCD) were optional, performed only at the discretion of the treatment team. A clinical research coordinator performed the raTCD procedure. The research coordinators had no prior TCD experience before being trained to perform standard TCD bubble study technique