Relationship of spontaneous microembolic signals to risk stratification, recurrence, severity, and mortality of ischemic stroke: a prospective study

Abstract

Introduction: The presence of microembolic signals (MES) during the acute phase of stroke is poorly understood, and its role and clinical application in relation to risk stratification and prognosis in patients remain uncertain. We assessed the prevalence of spontaneous MES in acute stroke and their relationship with risk stratification, stroke recurrence, morbidity, and mortality. Patients and methods:This was a prospective cohort study conducted in the Stroke Unit. The MES presence was evaluated by transcranial Doppler (TCD) in patients with ischemic stroke within 48 h. The outcomes (risk stratification, morbidity, mortality, and recurrence of a stroke) were followed up for 6 months. The relationship between risk stratification and MES was obtained by odds ratios and that between MES and stroke recurrence, morbidity, and mortality using multiple logistic regression; considering statistical significance at P < 0.05. Results:Of the 111 patients studied, 70 were men (63.1%) and 90 were white (81.1%), with a median age of 68 years. The MES frequency was 7%. There was a significant relationship between MES and symptomatic carotid disease (OR = 22.7; 95% CI 4.1-125.7; P < 0.001), a shorter time to monitoring (OR = 12.4; 95% CI 1.4-105.4; P = 0.02), and stroke recurrence (OR = 16.83; 95% CI 2.01-141; P = .009). Discussion:It was observed that the stroke recurrence adjusted for prior stroke was higher and earlier among patients with MES detection. In conclusion, MES demonstrated a significant correlation with symptomatic carotid disease and a shorter DELAY until monitoring, and could be a predictor for the early recurrence of stroke in the long term.

Micro-embolic signal monitoring in stroke subtypes: A systematic review and meta-analysis of 58 studies

“…[3][4][5] Studies have also investigated the significance of MES with risk of future cerebral ischemic events and their outcome. 6,7 Majority of these are small, underpowered studies and still substantial uncertainty exists about the results of these studies and their impact on clinical practice. Larger prospective studies on MES in stroke patients are hampered owing to the time consumption and difficulties involved in performing the procedure.…”

Microembolic Signals Detected by Transcranial Doppler Predict Future Stroke and Poor Outcomes

“…In a study of anterior circulation ischemic stroke patients, MES did not predict neurological outcome at 3 months after stroke 34 . Furthermore, in a recent study of prospective enrolled patients with anterior circulation stroke, the presence of MES was not associated with favorable outcomes (mRS < 3) at 6 months or mortality 35 . These studies, however, recruited a small number of patients and may have been underpowered to detect any significant differences in clinical outcomes.…”

“…34 Furthermore, in a recent study of prospective enrolled patients with anterior circulation stroke, the presence of MES was not associated with favorable outcomes (mRS < 3) at 6 months or mortality. 35 These studies, however, recruited a small number of patients and may have been underpowered to detect any significant differences in clinical outcomes. In our study, despite controlling for ischemic recurrence in our multivariate model, MES independently correlated with poor discharge outcome.…”

Vzaimosvyaz' faktorov riska mikroembolii s vozrastom v vosstanovitel'nom periode ishemicheskogo insul'ta

“…Эмболия в сосуды головного мозга является одной из наиболее частых причин развития ишемического инсульта (ИИ) [1][2][3][4]. Источники эмболии и сам эмболический материал при этом крайне гетерогенны [5].…”

“…Имеются сведения, что риск инсульта увеличивается с длительностью ФП и, соответственно, возрастом [10,15]. Атеросклероз в качестве причины ИИ реализует свой потенциал различными путями: посредством атеротромбоза, гипоперфузии или артерио-артериальной эмболии [1,2]. Частота каждого из обозначенных механизмов точно не установлена, но известно, что наиболее редким из трех является гипоперфузия [5,6].…”