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Clinical Significance of Microembolic Signal Detection in Acute Ischemic Stroke: Insights Into Ongoing Cerebral

Eleni Bakola1, Lina Palaiodimou1, Aikaterini Theodorou1

  • 1Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece.

European Journal of Neurology
|February 27, 2026
PubMed
Abstract

Insights

Microembolic signals (MES) detected via transcranial Doppler (TCD) in acute ischemic stroke (AIS) patients were associated with specific stroke causes like atrial fibrillation and cancer, and absent in lacunar stroke.

Area of Science:

  • Neurology
  • Cardiology
  • Oncology

Background:

  • Microembolic signals (MES) detected by transcranial Doppler (TCD) indicate ongoing cerebral embolization.
  • MES research spans stroke subtypes, aiding etiology clarification, treatment monitoring, and recurrence prediction.

Purpose of the Study:

  • Determine MES prevalence in acute ischemic stroke (AIS).
  • Explore clinical and laboratory associations with MES.
  • Assess MES utility in etiological stroke workup.

Main Methods:

  • Prospective single-center study over 3 years.
  • Included anterior circulation AIS patients within 24 hours of onset.
  • Bilateral middle cerebral artery TCD monitoring for 30 minutes to detect and quantify MES.

Main Results:

  • MES detected in 16.2% of 136 AIS patients; absent in lacunar stroke.
  • MES positivity linked to multiple-territory infarcts, new atrial fibrillation, and cancer-associated stroke.
  • MES counts correlated with elevated D-dimer levels, indicating a prothrombotic state.

Conclusions:

  • MES are present in a significant portion of AIS patients, excluding lacunar stroke.
  • MES presence correlates with specific etiologies including atrial fibrillation and cancer.
  • MES and D-dimer levels suggest ongoing embolization and prothrombotic conditions, aiding in occult embolic mechanism identification.
Keywords:
acute ischemic strokeatrial fibrillationcancer‐associated strokemicroembolic signalstranscranial doppler

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