TEE, cardiac CT, and cardiac MRI will provide actionable information in a minority of patients with acute stroke. In a prospective study of 61 patients with ESUS who underwent investigation with TEE (mean age, 44 12 years; 49% men), TEE revealed additional findings in 52% (95% CI, 40 65) of the study population, and findings changed manage- ment (initiation of anticoagulation therapy, admin- istration of intravenous antibiotic therapy, and PFO In a meta-analysis of 3562 patients with acute isch- emic stroke, the pooled rate of anticoagulation therapy attributed to abnormal TEE findings was In a single-center ret- rospective study of 1458 patients with suspected cardioembolic stroke, findings on TEE significantly changed management in 16.7%.77 Smaller series have found that the addition of TEE to a standard stroke workup identified an indication for antico- Cardiac CT has a modest sensitivity (72%) and high speci- ficity (95%) for detecting potential embolic source in patients with cryptogenic stroke in whom TEE is used as the gold standard.78 A single-center study of consecutive patients with cryptogenic stroke who underwent both TEE and cardiac MRI found that cardiac MRI reduced the percentage of patients with cryptogenic stroke by only slightly >1%.79 14. TCD compares favorably with TEE for detecting right-to-left shunting, which is usually the result of PFO, now a potential target for device closure. 