Microemboli-monitoring During the Acute Phase of Ischemic Stroke: is It Worth the Time?

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2010 Sep 14

PMID 20831778

Citations 5

Authors

Titto T Idicula

Halvor Naess

Lars Thomassen

Affiliations

Soon will be listed here.

Abstract

Background: The prevalence of microembolic signals (MES) during the acute phase of ischemic stroke and its influence on outcome is not well studied. The aim of our study was to determine the prevalence of MES, the different factors that are associated with the presence of MES and the association between MES and outcomes in stroke patients investigated within 6 hours after the onset of ischemic stroke.

Methods: We included unselected ischemic stroke patients who underwent microemboli-monitoring within six hours after stroke onset. Microemboli-monitoring of both middle cerebral arteries (MCA) was done for a period of 1 hour using 2-MHz probes applied over the trans-temporal window. Prevalence of MES, predictors for the presence of MES and the association between MES and various outcome factors were analyzed.

Results: Forty patients were included. The mean age of the patients was 70 years. The prevalence of either ipsilateral or contralateral MES were 25% (n = 10). The predictors for the presence of MES were older age (OR 9; p = 0.03), higher NIHSS (OR 28; p = 0.02), intracranial stenosis (OR 10; p = 0.04) and embolic stroke (large-artery atherosclerosis and cardioembolism on TOAST classification) (OR 7; p = 0.06). MES were not independently associated with short-term functional outcome, long-term mortality or future vascular events.

Conclusions: MES are moderately frequent following acute ischemic stroke. Microemboli-monitoring helps to better classify the stroke etiology. However, the presence MES did not have any prognostic significance in this study.

Citing Articles

Microembolic signal detection in acute ischemic stroke: Clinical relevance and impact on treatment individualization-A narrative review.

Bakola E, Palaiodimou L, Kargiotis O, Safouris A, Psychogios K, Karapanayiotides T Eur J Neurol. 2024; 32(1):e16584.

PMID: 39706201 PMC: 11661863. DOI: 10.1111/ene.16584.

MRI-based microthrombi detection in stroke with polydopamine iron oxide.

Jacqmarcq C, Picot A, Flon J, Lebrun F, Martinez de Lizarrondo S, Naveau M Nat Commun. 2024; 15(1):5070.

PMID: 38871729 PMC: 11176332. DOI: 10.1038/s41467-024-49480-x.

Rs4612666 Polymorphism of the NLRP3 Gene Is Associated with the Occurrence of Large Artery Atherosclerotic Ischemic Strokes and Microembolic Signals.

Cheng L, Yin R, Yang S, Pan X, Ma A Biomed Res Int. 2018; 2018:6345805.

PMID: 29850543 PMC: 5937605. DOI: 10.1155/2018/6345805.

Cardioembolism and Involvement of the Insular Cortex in Patients with Ischemic Stroke.

Kang J, Hong J, Jang M, Kim B, Bae H, Han M PLoS One. 2015; 10(10):e0139540.

PMID: 26489090 PMC: 4619548. DOI: 10.1371/journal.pone.0139540.

Focal embolic cerebral ischemia in the rat.

Zhang L, Zhang R, Jiang Q, Ding G, Chopp M, Zhang Z Nat Protoc. 2015; 10(4):539-47.

PMID: 25741989 PMC: 4602402. DOI: 10.1038/nprot.2015.036.

References

Poppert H, Sadikovic S, Sander K, Wolf O, Sander D . Embolic signals in unselected stroke patients: prevalence and diagnostic benefit. Stroke. 2006; 37(8):2039-43. DOI: 10.1161/01.STR.0000231644.47325.aa. View

Gucuyener D, Uzuner N, Ozkan S, Ozdemir O, Ozdemir G . Micro embolic signals in patients with cerebral ischaemic events. Neurol India. 2001; 49(3):225-30. View

Georgiadis D, Grosset D, Kelman A, Faichney A, Lees K . Prevalence and characteristics of intracranial microemboli signals in patients with different types of prosthetic cardiac valves. Stroke. 1994; 25(3):587-92. DOI: 10.1161/01.str.25.3.587. View

Serena J, Segura T, Castellanos M, Davalos A . Microembolic signal monitoring in hemispheric acute ischaemic stroke: a prospective study. Cerebrovasc Dis. 2000; 10(4):278-82. DOI: 10.1159/000016070. View

Sliwka U, Lingnau A, Stohlmann W, Schmidt P, Mull M, Diehl R . Prevalence and time course of microembolic signals in patients with acute stroke. A prospective study. Stroke. 1997; 28(2):358-63. DOI: 10.1161/01.str.28.2.358. View

Sitzer M, Muller W, Siebler M, Hort W, Kniemeyer H, Jancke L . Plaque ulceration and lumen thrombus are the main sources of cerebral microemboli in high-grade internal carotid artery stenosis. Stroke. 1995; 26(7):1231-3. DOI: 10.1161/01.str.26.7.1231. View

Ritter M, Dittrich R, Thoenissen N, Ringelstein E, Nabavi D . Prevalence and prognostic impact of microembolic signals in arterial sources of embolism. A systematic review of the literature. J Neurol. 2008; 255(7):953-61. DOI: 10.1007/s00415-008-0638-8. View

Del Sette M, Angeli S, Stara I, Finocchi C, Gandolfo C . Microembolic signals with serial transcranial Doppler monitoring in acute focal ischemic deficit. A local phenomenon?. Stroke. 1997; 28(7):1311-3. DOI: 10.1161/01.str.28.7.1311. View

Koennecke H, Mast H, Trocio Jr S, Sacco R, Ma W, Mohr J . Frequency and determinants of microembolic signals on transcranial Doppler in unselected patients with acute carotid territory ischemia. A prospective study. Cerebrovasc Dis. 1998; 8(2):107-12. DOI: 10.1159/000015827. View

10.

Adams Jr H, Bendixen B, Kappelle L, Biller J, Love B, Gordon D . Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24(1):35-41. DOI: 10.1161/01.str.24.1.35. View

11.

Tong D, Albers G . Transcranial Doppler-detected microemboli in patients with acute stroke. Stroke. 1995; 26(9):1588-92. DOI: 10.1161/01.str.26.9.1588. View

12.

Wahlgren N, Ahmed N, Davalos A, Ford G, Grond M, Hacke W . Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet. 2007; 369(9558):275-82. DOI: 10.1016/S0140-6736(07)60149-4. View

13.

Lund C, Rygh J, Stensrod B, Sandset P, Brucher R, Russell D . Cerebral microembolus detection in an unselected acute ischemic stroke population. Cerebrovasc Dis. 2000; 10(5):403-8. DOI: 10.1159/000016097. View

14.

Jansen C, Ramos L, van Heesewijk J, Moll F, van Gijn J, Ackerstaff R . Impact of microembolism and hemodynamic changes in the brain during carotid endarterectomy. Stroke. 1994; 25(5):992-7. DOI: 10.1161/01.str.25.5.992. View

15.

Kolominsky-Rabas P, Weber M, Gefeller O, Neundoerfer B, Heuschmann P . Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001; 32(12):2735-40. DOI: 10.1161/hs1201.100209. View

16.

Finocchi C, Del Sette M, Serrati C, Gandolfo C . Transcranial Doppler-detected microemboli in patients with acute stroke. Stroke. 1996; 27(4):767-8. View

17.

Ringelstein E, Droste D, Babikian V, Evans D, Grosset D, Kaps M . Consensus on microembolus detection by TCD. International Consensus Group on Microembolus Detection. Stroke. 1998; 29(3):725-9. DOI: 10.1161/01.str.29.3.725. View

18.

Valton L, Larrue V, le Traon A, Massabuau P, Geraud G . Microembolic signals and risk of early recurrence in patients with stroke or transient ischemic attack. Stroke. 1998; 29(10):2125-8. DOI: 10.1161/01.str.29.10.2125. View

19.

Delcker A, Schnell A, Wilhelm H . Microembolic signals and clinical outcome in patients with acute stroke--a prospective study. Eur Arch Psychiatry Clin Neurosci. 2000; 250(1):1-5. DOI: 10.1007/pl00007532. View

20.

Goertler M, Baeumer M, Kross R, Blaser T, Lutze G, Jost S . Rapid decline of cerebral microemboli of arterial origin after intravenous acetylsalicylic acid. Stroke. 1999; 30(1):66-9. DOI: 10.1161/01.str.30.1.66. View