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Microembolus detection in patients with Takayasu's arteritis
Emre Kumral1, Dilek Evyapan, Kenan Aksu
1Department of Neurology, Ege University Faculty of Medicine, Izmir, Turkey. ekumral@med.ege.edu.tr
Background And Purpose:
Takayasu's arteritis (TA) is a chronic inflammatory disease of unknown etiology that can affect the aorta and its branches. The cerebral ischemia in TA can be caused by a variety of mechanisms, and the focus of this study is to detect the possible contribution of microembolus in the pathogenesis of stroke.
Methods:
Eighteen patients with TA according to the criteria for the classification of TA of the American College of Rheumatology and 100 age-matched healthy controls were studied. Both middle cerebral arteries were monitored by transcranial Doppler (TCD) ultrasound for at least 30 minutes. All patients with TA were followed up for a mean duration of 2.1 months, and recurrent strokes were registered.
Results:
Microembolic signals (MES) were present in 22% of the patients overall, and the intensity of the MES varied between 9 and 30 dB. Moreover, MES were found in 30% of the patients with higher erythrocyte sedimentation rate. Two (67%) of 3 patients who did not receive any treatment had MES, but only 2 (13%) of 15 patients who received immunosuppressive and anticoagulant therapy before the TCD ultrasonography monitoring had MES. During the follow-up period after MES recording, we did not observe any recurrent stroke.
Conclusions:
TCD ultrasonography monitoring can be used as an additional noninvasive procedure to detect microembolus in patients with TA during the acute and chronic phase of the disease. The monitoring of MES may also help in choosing better treatment for the long-term prophylaxis of the disease from acute ischemic stroke, but further large studies are required to justify the efficacy of immunosuppressive treatment in these patients.
Insights
Microemboli contribute to stroke in Takayasu
Area of Science:
- Neurology
- Rheumatology
- Vascular Medicine
Background:
- Takayasu's arteritis (TA) is a chronic inflammatory disease affecting the aorta and its branches.
- Cerebral ischemia in TA can arise from various mechanisms.
- This study investigates the role of microemboli in TA-related stroke pathogenesis.
Purpose of the Study:
- To detect the potential contribution of microemboli to stroke in patients with Takayasu's arteritis.
- To assess the utility of transcranial Doppler (TCD) ultrasound in identifying microembolic signals (MES).
Main Methods:
- 18 patients with Takayasu's arteritis (TA) and 100 age-matched healthy controls were studied.
- Transcranial Doppler (TCD) ultrasound monitored middle cerebral arteries for microembolic signals (MES).
- Patients were followed up for recurrent strokes.
Main Results:
- Microembolic signals (MES) were detected in 22% of TA patients.
- MES prevalence was higher in patients with elevated erythrocyte sedimentation rates and those untreated.
- Only 13% of treated patients (immunosuppressive and anticoagulant therapy) showed MES, compared to 67% of untreated patients.
Conclusions:
- TCD ultrasound is a valuable noninvasive tool for detecting microemboli in TA patients.
- Monitoring MES may guide long-term stroke prophylaxis strategies.
- Further research is needed to confirm the efficacy of immunosuppressive treatment for stroke prevention in TA.