Cerebral microembolus detection in an unselected acute ischemic stroke population

Area of Science:

• Neurology
• Cardiovascular Medicine
• Medical Imaging

Background:

• Acute ischemic stroke is a leading cause of disability.
• Cerebral microemboli are implicated in stroke pathogenesis but their prevalence and significance in unselected populations are not fully understood.
• Current stroke classification may not fully capture the role of microemboli.

Purpose of the Study:

• To determine the prevalence, frequency, and clinical significance of cerebral microemboli in acute ischemic stroke patients.
• To evaluate the utility of transcranial Doppler (TCD) monitoring for detecting microemboli.
• To assess if microemboli detection can enhance ischemic stroke subtype classification.

Main Methods:

• 120 consecutive patients with internal carotid artery territory ischemia underwent TCD monitoring of the middle cerebral artery (MCA) within 72 hours and 5 days of symptom onset.
• Platelet and coagulation activation markers were measured in a subset of patients.
• Strokes were classified using the TOAST criteria, and clinical status was assessed at discharge.

Main Results:

• Microembolus monitoring was feasible in 69.2% of patients.
• Cerebral microemboli were detected in 26.5% of patients, despite antiplatelet or anticoagulant therapy.
• Microemboli were more prevalent in cardioembolic strokes (p=0.047) but not associated with clinical outcome or coagulation parameters.

Conclusions:

• Cerebral microemboli are frequent in acute ischemic stroke patients, even when on antithrombotic treatment.
• TCD detection of microemboli provides important pathophysiological information.
• Microemboli detection using TCD can potentially improve the classification of ischemic stroke subtypes.