Microembolus detection in patients with Takayasu's arteritis.
OBJECTIVE
Takayasu's arteritis (TA) is a chronic inflammatory disease of unknown etiology that can affect the aorta and its branches. The cerebral ischemia in TA can be caused by a variety of mechanisms, and the focus of this study is to detect the possible contribution of microembolus in the pathogenesis of stroke.


METHODS
Eighteen patients with TA according to the criteria for the classification of TA of the American College of Rheumatology and 100 age-matched healthy controls were studied. Both middle cerebral arteries were monitored by transcranial Doppler (TCD) ultrasound for at least 30 minutes. All patients with TA were followed up for a mean duration of 2.1 months, and recurrent strokes were registered.


RESULTS
Microembolic signals (MES) were present in 22% of the patients overall, and the intensity of the MES varied between 9 and 30 dB. Moreover, MES were found in 30% of the patients with higher erythrocyte sedimentation rate. Two (67%) of 3 patients who did not receive any treatment had MES, but only 2 (13%) of 15 patients who received immunosuppressive and anticoagulant therapy before the TCD ultrasonography monitoring had MES. During the follow-up period after MES recording, we did not observe any recurrent stroke.


CONCLUSIONS
TCD ultrasonography monitoring can be used as an additional noninvasive procedure to detect microembolus in patients with TA during the acute and chronic phase of the disease. The monitoring of MES may also help in choosing better treatment for the long-term prophylaxis of the disease from acute ischemic stroke, but further large studies are required to justify the efficacy of immunosuppressive treatment in these patients.
Kumral
Emre
E
Department of Neurology, Ege University Faculty of Medicine, Izmir, Turkey. ekumral@med.ege.edu.tr
Evyapan
Dilek
D
Aksu
Kenan
K
Keser
Gökhan
G
Kabasakal
Yasemin
Y
Balkir
Kaan
K
D000293:Adolescent; D000328:Adult; D001799:Blood Sedimentation; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012307:Risk Factors; D013625:Takayasu Arteritis / Q000145:classification* / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D017585:Ultrasonography, Doppler, Transcranial