title: Spontaneous cerebral embolisation in asymptomatic and recently symptomatic patients with TIA/Minor stroke.
abstract: OBJECTIVE
  Spontaneous embolisation (SE) detected using Transcranial Doppler (TCD) after a Transient Ischaemic Attack (TIA)/Minor stroke is an independent predictor of recurrent stroke. There are, however limited data on the differential prevalence of SE in the first few days/weeks after onset of symptoms.
  
  
  METHODS
  156 consecutive patients (symptomatic n = 123, asymptomatic n = 33) underwent Carotid Endarterectomy (CEA) during an 18 month period and had an accessible window permitting 30 min of pre-operative TCD monitoring. A prospective study was conducted with assessors blinded to clinical status.
  
  
  RESULTS
  Spontaneous embolisation was detected in 31 symptomatic patients (25%) of which 1/1 (100%), 14/35 (40%), 8/37 (22%) and in 8/50 (16%) patients presented within 48 h, 3-7 days, 8-14 days and >14 days respectively from the index clinical event. SE occurred in only 6% of asymptomatic patients. Out of 31 symptomatic patients with SE, seven (22.6%) suffered recurrent cerebrovascular events following admission as opposed to 11/92 patients (11.9%) who had no evidence of spontaneous embolisation after admission (OR 2.2 (95% CI 0.8-6.1))(P = 0.2)
  
  
  CONCLUSIONS
  Patients presenting for CEA in the hyperacute period after onset of TIA/Minor stroke have a high incidence of SE. Patients with SE had a 23% risk of recurrent cerebrovascular events. These data support the current drive towards expedited CEA in recently symptomatic patients.
authors.affiliation: Vascular Surgery Group, Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, LE2 7LX, United Kingdom. ms447@le.ac.uk
authors.forename: M K
authors.initials: MK
authors.lastname: Salem
authors.forename: H Z
authors.initials: HZ
authors.lastname: Butt
authors.forename: A P W
authors.initials: AP
authors.lastname: Watts
authors.forename: R D
authors.initials: RD
authors.lastname: Sayers
authors.forename: M J
authors.initials: MJ
authors.lastname: Bown
authors.forename: A R
authors.initials: AR
authors.lastname: Naylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D016022:Case-Control Studies; D015331:Cohort Studies; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000453:epidemiology*; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D017585:Ultrasonography, Doppler, Transcranial