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Microembolic signals and antiplatelet therapy in Moyamoya angiopathy
Mosche Pompsch1, Roland Veltkamp1,2, Rolf R Diehl1,3
1Department of Neurology, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45130, Essen, Germany.
Background:
Embolism as a cause of stroke is widely neglected in Moyamoya angiopathy (MMA), and recommendations for use of antiplatelet therapy (APT) vary. We examined the presence of microembolic signals (MES) during transcranial Doppler (TCD) monitoring and assessed the effects of APT on the occurrence of MES in MMA.
Patients And Methods:
We retrospectively analysed patients with MMA treated at our centre between 2011 and 2021. TCD was performed at first presentation and at most visits, while number of visits varied between individual patients. TCD was performed for 30 min bilaterally. Patient demographics, vascular risk factors, and antiplatelet treatment were collected from each clinic visit and ischemic and haemorrhagic episodes were captured as recorded during follow-up visits.
Results:
209 patients were included in the analysis (mean age 38.7 ± 15.3, 28% male). 21 patients with 27 MES-positive TCD examinations were identified (10%). Patient characteristics were similar in MES-positive and MES-negative groups. However, recent ischemic events were detected at a significantly higher rate in MES-positive patients (42.9% vs 4.8%, p < 0.001). After MES detection, change of antiplatelet drug regime was performed, leading to loss of MES in all cases. Dual APT was preferably used in the MES-positive group (p < 0.001) but no significant difference of haemorrhage during follow-up-visits was observed. Reduction of APT before bypass-surgery triggered MES in four patients.
Conclusion:
APT is required in patients with MMA. MES monitoring may help to identify risk patients in need of intensified APT.
Insights
Antiplatelet therapy (APT) is crucial for Moyamoya angiopathy (MMA) patients. Microembolic signals (MES) detected via transcranial Doppler (TCD) monitoring indicate stroke risk and guide intensified APT, improving patient outcomes.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Imaging
Background:
- Embolism is an underrecognized cause of stroke in Moyamoya angiopathy (MMA).
- Current recommendations for antiplatelet therapy (APT) in MMA are inconsistent.
- Microembolic signals (MES) are potential indicators of embolic events in MMA.
Purpose of the Study:
- To investigate the prevalence of MES in MMA patients using transcranial Doppler (TCD).
- To assess the impact of APT on MES occurrence in MMA.
- To identify risk factors and guide treatment strategies for embolic events in MMA.
Main Methods:
- Retrospective analysis of 209 MMA patients treated between 2011 and 2021.
- Bilateral transcranial Doppler (TCD) monitoring for 30 minutes at multiple visits.
- Collection of patient demographics, vascular risk factors, APT regimens, and clinical outcomes (ischemic/hemorrhagic events).
Main Results:
- 10% of patients (21/209) showed MES on TCD.
- MES-positive patients had a significantly higher rate of recent ischemic events (42.9% vs. 4.8%).
- Intensified APT, particularly dual APT, resolved MES in all cases without increasing hemorrhage risk. Reduction in APT preceded MES occurrence in 4 patients.
Conclusions:
- Antiplatelet therapy (APT) is essential for managing MMA patients.
- Microembolic signal (MES) monitoring via TCD can identify high-risk patients requiring intensified APT.
- MES monitoring aids in optimizing APT strategies to prevent embolic stroke in MMA.
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