title: Microembolic signals on transcranial Doppler ultrasound are correlated with platelet activation markers, but not with platelet-leukocyte associates: a study in patients with acute stroke and in patients with asymptomatic carotid stenosis.
abstract: BACKGROUND
  The in vivo correlates of microembolic signals (MES) are still unknown. Platelet-associates (PA) with monocytes or granulocytes or platelet aggregates only may represent these correlates.
  
  
  METHODS
  Thirty patients with asymptomatic carotid stenosis >50% and 16 patients with acute (<4 days) atherothrombotic stroke were investigated. PA, P-selectin and thrombospondin expressions on platelets were assessed by flow cytometry. Soluble P-selectin (sPS) levels were assessed. MES detections were performed by transcranial Doppler sonography for 1 hour. PA, P-selectin and thrombospondin expressions on platelets and sPS levels were compared between MES-positive (MES+) and MES-negative (MES-) patients.
  
  
  RESULTS
  Eight patients (27%) with asymptomatic carotid stenosis had 1-26 MES/h. Degree of stenosis was 78 +/- 10% in MES- and 88 +/- 8% in the MES+ (p=0.01). There were no differences in percentages of PA. P-selectin and thrombospondin surface expression was lower in MES+, but this was not significant. sPS levels were higher in MES+ (122 +/- 27 ng/ml versus 80 +/- 25 ng/ml in MES-, p=0.01). Seven (44%) patients with stroke had 1-39 MES/h. There were no differences in percentages of PA. MES+ had higher sPS levels (178 +/- 43 versus 121 +/- 44 ng/ml, p=0.02) and less P-selectin surface expression than MES- (9.0 +/- 3.4 versus 4.5 +/- 1.6%, p=0.004).
  
  
  CONCLUSIONS
  High levels of sPS in MES+ and lower expression of platelet activation markers on platelets' surface suggest shedding of activation markers from the platelets' surface and thus enhanced activation of platelets of MES+ compared with MES-. PA are probably not the clinical correlates of MES, but platelets seem to be the main cellular element of solid cerebral microemboli.
authors.affiliation: Department of Neurology, Experimental and Clinical Hemostasis, University of Münster, Münster, Germany. ritterm@uni-muenster.de
authors.forename: Martin A
authors.initials: MA
authors.lastname: Ritter
authors.forename: Kerstin
authors.initials: K
authors.lastname: Jurk
authors.forename: Carsten
authors.initials: C
authors.lastname: Schriek
authors.forename: Darius G
authors.initials: DG
authors.lastname: Nabavi
authors.forename: Dirk W
authors.initials: DW
authors.lastname: Droste
authors.forename: Beate E
authors.initials: BE
authors.lastname: Kehrel
authors.forename: E
authors.initials: E
authors.lastname: Bernd Ringelstein