Microembolic signals and risk of early recurrence in patients with stroke or transient ischemic attack.
OBJECTIVE
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.
Department of Neurology, Rangueil Hospital, University of Toulouse, Toulouse, France.
L
L
Valton
V
V
Larrue
A P
AP
le Traon
P
P
Massabuau
G
G
Géraud
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D002561:Cerebrovascular Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D002542:Intracranial Embolism and Thrombosis / Q000150:complications*; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial