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[Detection of cardiac embolism by transcranial Doppler]
G Pettelot1, M Baudouy, P Morand
1Service de Cardiologie, Hôpital Pasteur, NICE.
Insights
Transcranial Doppler can detect cerebral emboli using high-intensity transient signals (HITS). This method aids in identifying embolic origins of cerebrovascular accidents and assessing treatment efficacy.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Imaging
Background:
- Cerebral emboli are a significant cause of cerebrovascular accidents (CVAs).
- Identifying the embolic source is crucial for effective treatment and prevention.
- Current diagnostic methods may not always detect transient embolic events.
Purpose of the Study:
- To evaluate the utility of transcranial Doppler (TCD) for detecting cerebral embolic signals.
- To characterize the high-intensity transient signals (HITS) associated with emboli.
- To explore the clinical applications of HITS detection in various patient populations.
Main Methods:
- Long-term monitoring of the middle cerebral artery using transcranial Doppler.
- Analysis of signal characteristics to identify high-intensity transient signals (HITS).
- Correlation of HITS detection with patient conditions and interventions.
Main Results:
- HITS were detected in patients with conditions predisposing to emboli, including prosthetic heart valves, atrial fibrillation, myocardial infarction, CVAs, carotid stenosis, and aortic plaques.
- HITS were also observed during cardiac and carotid surgery and angiography.
- The presence of HITS can support an embolic etiology for cerebrovascular events.
Conclusions:
- Transcranial Doppler with long-term monitoring is effective in detecting cerebral embolic signals (HITS).
- HITS detection offers a valuable tool for diagnosing embolic strokes and investigating emboligenic heart disease.
- This technique has broad applications in managing patients at risk of or experiencing embolic events and evaluating treatment effectiveness.
Abstract:
Cerebral emboli, regardless of their nature, can be detected by transcranial Doppler by performing long-term recordings of the middle cerebral artery. The signals detected, called HITS (high intensity transient signals) described in vitro and in vivo have particular physical characteristics. These embolic signals have been identified in patients with prosthetic heart valves, in patients with atrial fibrillation, following myocardial infarction, following cerebrovascular accident, in patients with carotid stenosis or aortic plaques, during cardiac and carotid surgery and during carotid angiography. During assessment of a cerebrovascular accident, the discovery of HITS could be an argument in favour of an embolic origin. This new technique raises great hopes for establishing the relationship between the discovery of emboligenic heart disease and their neurological clinical manifestations. This new technique has many fields of application: investigation of asymptomatic emboli in patients with emboligenic heart disease, efficacy of antiaggregant, anticoagulant or surgical treatments.