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Microembolic signals and risk of early recurrence in patients with stroke or transient ischemic attack
L Valton1, V Larrue, A P le Traon
1Department of Neurology, Rangueil Hospital, University of Toulouse, Toulouse, France.
Background And Purpose:
Asymptomatic microembolic signals (MES) can be demonstrated in patients with cerebral ischemia using transcranial Doppler (TCD) ultrasonographic monitoring of the middle cerebral artery. However, the clinical relevance of MES remains uncertain. The purpose of this study was to estimate the independent contribution of microembolism to the risk of early ischemic recurrence (EIR) in patients with stroke or transient ischemic attack (TIA) of presumed arterial origin.
Methods:
We studied the incidence of EIR in 73 consecutive patients with carotid stroke or TIA in whom TCD scanning of the symptomatic middle cerebral artery was performed within 7 days from the onset of symptoms. Patients with a potential cardiac source of embolism were excluded from the study.
Results:
Eight patients had EIR during a mean+/-SD follow-up of 10+/-8 days. The incidence of EIR was 4.3 per 100 patient-days in patients with MES and only 0.5 per 100 patient-days in patients without MES. The presence of MES was a significant predictor of EIR after adjustment for the presence of carotid stenosis or aortic arch atheroma, antiplatelet therapy during follow-up, and other potential confounding variables (relative risk, 8.7; 95% confidence interval, 2 to 38.2; P=0.0015).
Conclusions:
Microembolism is a significant independent predictor of EIR in patients with stroke or TIA of presumed arterial origin.
Insights
Asymptomatic microembolic signals (MES) detected via transcranial Doppler (TCD) are a significant predictor of early ischemic recurrence (EIR) in stroke and TIA patients. This finding highlights the clinical relevance of microembolism in arterial disease.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Asymptomatic microembolic signals (MES) are detectable using transcranial Doppler (TCD) in patients with cerebral ischemia.
- The clinical significance of MES in predicting future ischemic events remains uncertain.
Purpose of the Study:
- To determine the independent contribution of microembolism to the risk of early ischemic recurrence (EIR).
- To assess the predictive value of MES in patients with stroke or transient ischemic attack (TIA) of arterial origin.
Main Methods:
- Prospective study of 73 consecutive patients with carotid stroke or TIA.
- Transcranial Doppler (TCD) monitoring of the symptomatic middle cerebral artery within 7 days of symptom onset.
- Exclusion of patients with potential cardiac sources of embolism.
Main Results:
- Eight patients experienced EIR during a mean follow-up of 10 days.
- EIR incidence was significantly higher in patients with MES (4.3 per 100 patient-days) compared to those without (0.5 per 100 patient-days).
- MES presence was an independent predictor of EIR (RR, 8.7; P=0.0015) after adjusting for confounders.
Conclusions:
- Microembolism, detected as MES, is a significant independent predictor of early ischemic recurrence.
- These findings underscore the clinical relevance of microembolism in patients with stroke or TIA of arterial origin.