Imaging recommendations based on acute treatment Recommendations for Diagnostic Evaluation (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES Kleindorfer considerations overlap with, but are not identical to, imaging recommendations based on secondary stroke prevention considerations. Recommendations presented in this guide- linefocusonevaluationsdoneforthepurposesofconfirming the diagnosis of stroke and characterizing its pathomecha- nism by identifying potential sources of cardioembolism, thromboembolism from large artery atherosclerosis, dissec- tion, or other disease processes such as hypercoagulability. Confirmation of stroke diagnosis may require follow-up head imaging because of poor sensitivity of noncontrast CT for small or hyperacute infarcts. Some conditions associated with stroke and with specific therapies are common (eg, AF), whereas others are relatively rare (eg, endocarditis). The variable yield of testing means that treating physicians need to exercise judgment on the likelihood that a test will alter management in a given clinical situation. Figure 2. Algorithm for evaluating patients with a clinical diagnosis of stroke for the purposes of optimizing prevention of recurrent ischemic stroke. Colors correspond to Class of Recommendation in Table 3. CT indicates computed tomography; CTA, computed tomography angiogram; ECG, electrocardiogram; MRA, magnetic resonance angiography; MRI, magnetic resonance imaging; PFO, patent foramen ovale; SOE, source of embolism; TCD, transcranial Doppler; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography; and US, ultrasound. *Basic laboratory tests include complete blood count, troponin, prothrombin time, partial thromboplastin time, glucose, hemoglobin A1c , creatinine, and fasting or nonfasting lipid profile. When a patient has a transient neurological deficit clinically characteristic of transient ischemic attack, the patient should be evaluated in the same manner as a patient who has an ischemic stroke with a corresponding cerebral infarct on imaging. TTE, TEE, TCD, cardiac MRI, or cardiac CT. CLINICAL STATEMENTS AND GUIDELINES Kleindorfer Recommendation-Specific Supportive Text 1. 