Microemboli-monitoring during the acute phase of ischemic stroke: is it worth the time?
Titto T Idicula1, Halvor Naess, Lars Thomassen
1Department of Neurology, Haukeland Hospital, Bergen, Norway. idic@helse-bergen.no
Background:
The prevalence of microembolic signals (MES) during the acute phase of ischemic stroke and its influence on outcome is not well studied. The aim of our study was to determine the prevalence of MES, the different factors that are associated with the presence of MES and the association between MES and outcomes in stroke patients investigated within 6 hours after the onset of ischemic stroke.
Methods:
We included unselected ischemic stroke patients who underwent microemboli-monitoring within six hours after stroke onset. Microemboli-monitoring of both middle cerebral arteries (MCA) was done for a period of 1 hour using 2-MHz probes applied over the trans-temporal window. Prevalence of MES, predictors for the presence of MES and the association between MES and various outcome factors were analyzed.
Results:
Forty patients were included. The mean age of the patients was 70 years. The prevalence of either ipsilateral or contralateral MES were 25% (n = 10). The predictors for the presence of MES were older age (OR 9; p = 0.03), higher NIHSS (OR 28; p = 0.02), intracranial stenosis (OR 10; p = 0.04) and embolic stroke (large-artery atherosclerosis and cardioembolism on TOAST classification) (OR 7; p = 0.06). MES were not independently associated with short-term functional outcome, long-term mortality or future vascular events.
Conclusions:
MES are moderately frequent following acute ischemic stroke. Microemboli-monitoring helps to better classify the stroke etiology. However, the presence MES did not have any prognostic significance in this study.
Insights
Microembolic signals (MES) are moderately common in acute ischemic stroke patients. While associated with older age and stroke severity, MES presence did not predict short-term outcomes or long-term mortality in this study.
Area of Science:
- Neurology
- Cerebrovascular Disease
- Stroke Medicine
Background:
- Microembolic signals (MES) prevalence and prognostic significance in acute ischemic stroke remain understudied.
- Early investigation (within 6 hours) is crucial for understanding acute stroke events.
- This study addresses the gap in knowledge regarding MES in the early phase of ischemic stroke.
Purpose of the Study:
- To determine the prevalence of MES in ischemic stroke patients within 6 hours of onset.
- To identify factors associated with the presence of MES.
- To evaluate the association between MES and stroke outcomes.
Main Methods:
- Included unselected ischemic stroke patients within 6 hours of symptom onset.
- Utilized 1-hour microemboli-monitoring of both middle cerebral arteries (MCA) via trans-temporal window.
- Analyzed MES prevalence, predictors, and association with outcomes.
Main Results:
- Prevalence of MES was 25% (10 out of 40 patients).
- Predictors for MES included older age, higher NIHSS score, intracranial stenosis, and embolic stroke etiology (TOAST classification).
- MES were not independently associated with short-term functional outcome, long-term mortality, or future vascular events.
Conclusions:
- Microembolic signals (MES) are moderately frequent in acute ischemic stroke.
- Microemboli-monitoring aids in classifying stroke etiology.
- MES presence did not demonstrate prognostic significance in this cohort.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies