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Prolonged and repeated microemboli detection in acute ischemic stroke - The Norwegian Microemboli in Acute Stroke

Sander Johan Aarli1, Lars Thomassen1, Nicola Logallo2

  • 1Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|July 7, 2024
PubMed
Abstract

Insights

Microembolic signals are common in acute ischemic stroke within 24 hours. However, extended and repeated monitoring did not significantly increase the detection of these signals in patients.

Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Medical Diagnostics

Background:

  • Cerebral microemboli detection using transcranial Doppler monitoring (TCDM) aids in understanding stroke causes and recurrence risk.
  • Standard TCDM monitoring duration may miss microembolizations due to temporal variability.
  • Assessing prolonged and repeated TCDM is crucial for optimizing microemboli detection.

Purpose of the Study:

  • To evaluate the time course of microembolization in acute ischemic stroke patients.
  • To determine the utility of prolonged and repeated microemboli detection in increasing diagnostic yield.
  • To explore the association between microemboli occurrence and clinical outcomes or stroke recurrence.

Main Methods:

  • Patients with suspected ischemic stroke underwent stationary TCDM for 1 hour, followed by ambulatory TCDM for 2 hours.
  • Unilateral TCDM was repeated over the next two days and at a three-month follow-up.
  • Data from 47 patients were analyzed, including those with ischemic stroke, transient ischemic attack, and amaurosis fugax.

Main Results:

  • Microemboli were detected in 60% of patients, with the highest occurrence within 24 hours of stroke onset.
  • Prolonged and repeated monitoring identified only one additional microemboli-positive patient.
  • No significant association was found between microemboli occurrence and clinical outcome or stroke recurrence.

Conclusions:

  • Microembolic signals are frequent in the early phase of acute ischemic stroke.
  • Extended and repeated TCDM monitoring does not substantially improve the detection rate of microemboli.
  • Early negative findings for microemboli tend to persist throughout monitoring.
Keywords:
Acute ischemic strokeCerebral infarctionEmbolismMicroemboli detectionMicroembolic signalsTranscranial Doppler

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