Occurrence of Transcranial Doppler High-Intensity Transient Signals in Patients With Potential Cardiac Sources of Embolism

Sliwka, Ulrich; Job, Frank-Peter; Wissuwa, Dorothee; Diehl, Rolf R.; Flachskampf, Frank-Arnold; Hanrath, Peter; Noth, Johannes

doi:10.1161/01.str.26.11.2067

Cited by 97 publications

(53 citation statements)

References 18 publications

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“…However, we found no evidence that any antithrombotic treatment was associated with the occurrence of HITS. This concurs with two previous reports addressing the frequency of HITS in patients with CSE [22, 23]. …”

Section: Discussionsupporting

confidence: 93%

Frequency and Determinants of Microembolic Signals on Transcranial Doppler in Unselected Patients with Acute Carotid Territory Ischemia

et al. 1998

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Background and Purpose: Few data exist regarding to the occurrence of microembolic high-intensity transient signals (HITS) on transcranial Doppler ultrasound (TCD) in unselected acute stroke patients. The aim of this study was to investigate prospectively the frequency and determinants of HITS in acute carotid territory ischemia. We hypothesized that carotid artery disease, cardiac abnormalities, and nonlacunar infarcts were independent predictors of HITS in acute stroke. Methods: We investigated 145 consecutive patients with acute internal carotid artery territory ischemia. The median time interval between stroke and TCD examination was 2 days. TCD monitoring was performed for 30 min on each middle cerebral artery. The frequency of HITS was cross-classified with carotid artery status, potential cardiac sources of embolism, and nonlacunar infarct subtype. Multivariate logistic regression models determined the independent relationship of these variables to HITS. Results: Microembolic signals were detected in 35 patients (24.1%), Ipsilateral carotid artery disease was significantly and independently associated with HITS (odds ratio 3.3, 95% confidence interval 1.4–7.8, p = 0.007), whereas potential cardiac sources (OR 1.07, 95% CI 0.48–2.4, p = 0.84) and infarct subtype (OR 0.84, 95% CI 0.29–2.4, p = 0.75) were not. Conclusions: High-intensity transient signals can be found in almost 25% of patients with acute anterior cerebral circulation ischemia and are significantly more prevalent among those with symptomatic carotid artery disease. Future clinical studies are required to determine whether HITS are a marker of increased stroke recurrence and can help to clarify stroke etiology in patients with competing stroke mechanisms.

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Section: Discussionsupporting

confidence: 93%

Frequency and Determinants of Microembolic Signals on Transcranial Doppler in Unselected Patients with Acute Carotid Territory Ischemia

et al. 1998

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“…Another difference in the selected patient population concerns potential cardiac sources of MES alike atrial fibrillation and in patients with heart valve prostheses. 10 In our study, we excluded patients with possible causes of MES other than the carotid arteries. Furthermore, the majority of our patients (88%) used lipid-lowering therapy, which is known to decrease the presence of MES.…”

Section: Discussionmentioning

confidence: 99%

Intraplaque Hemorrhage, Fibrous Cap Status, and Microembolic Signals in Symptomatic Patients With Mild to Moderate Carotid Artery Stenosis

Truijman

Rotte

Aaslid

et al. 2014

Stroke

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T o date, the degree of luminal narrowing by a carotid artery plaque is used to estimate the risk of recurrence of cerebrovascular events and to stratify therapeutic options.1 However, other plaque characteristics have gained interest. Detection of atherosclerotic plaques, which are prone to rupture, the socalled vulnerable plaques, might help in determining the best therapeutic approach, especially for patients with a mild to moderate carotid artery stenosis.Intraplaque hemorrhage (IPH) and fibrous cap (FC) status, as evaluated with MRI, are important features of plaque vulnerability and are associated with an increased risk of future ischemic stroke or transient ischemic attack.

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“…The combined use of both MCA insonation and extended time of MES recording increased the sensitivity of the method from 31% to 83.3% (9).…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies often included small patient populations, limited data, short recording times, and one insonated MCA (8,9). One trial demonstrated that the sensitivity and specificity of microembolic signal (MES) recordings detection method in patients with potential cardiac sources of embolism (one artery insonation during 30 minutes recording) was 31% and 95% respectively (9).…”

Section: Introductionmentioning

confidence: 99%

Incidence of neurological complications in patients with native-valve infective endocarditis and cerebral microembolism: An open cohort study

Lepur

Baršić

2009

Scandinavian Journal of Infectious Diseases

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Occurrence of Transcranial Doppler High-Intensity Transient Signals in Patients With Potential Cardiac Sources of Embolism

Abstract: HITS are common phenomena in patients with potential cardiac sources of embolism. The clinical relevance of these HITS remains unclear.

Cited by 97 publications

References 18 publications

Frequency and Determinants of Microembolic Signals on Transcranial Doppler in Unselected Patients with Acute Carotid Territory Ischemia

Frequency and Determinants of Microembolic Signals on Transcranial Doppler in Unselected Patients with Acute Carotid Territory Ischemia

Intraplaque Hemorrhage, Fibrous Cap Status, and Microembolic Signals in Symptomatic Patients With Mild to Moderate Carotid Artery Stenosis

Incidence of neurological complications in patients with native-valve infective endocarditis and cerebral microembolism: An open cohort study

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