title: Microembolic signals in acute posterior circulation cerebral ischemia: sources and consequences.
abstract: OBJECTIVE
  The clinical significance of microembolic signals (MES) in the posterior circulation remains unclear. The aim of this study was to investigate the sources and consequences of MES in acute posterior circulation cerebral ischemia.
  
  
  METHODS
  We evaluated a total of 140 consecutive patients (93 males, mean age 62.9 years) who had acute posterior circulation cerebral ischemia. The MES monitoring was conducted at the basilar artery through the suboccipital window for a 30-minute period.
  
  
  RESULTS
  MES were detected in 18 (12.9%) of the 140 patients. Clinical characteristics and laboratory data did not differ between the MES-positive and MES-negative groups. Intracranial vertebrobasilar artery (VBA) stenosis was independently associated with the presence of MES (odds ratio, 9.85; 95% confidence interval, 1.22-79.48; P=0.032), whereas the patients with vertebral artery stenosis that was limited to the extracranial portion did not show an association. Microembolic signals occurred significantly more frequently in patients with severe degree of VBA stenosis compared to those with nonsignificant stenosis (odds ratio, 9.88; 95% confidence interval, 1.23-79.07; P=0.031). In a subgroup analysis of the 79 patients who had lesions on diffusion-weighted images and relevant VBA stenosis, the MES-positive group showed more frequent embolic infarction (P=0.010) and multiple lesion patterns (P=0.007) than single perforating infarctions.
  
  
  CONCLUSIONS
  In acute posterior circulation cerebral ischemia, intracranial and severe VBA stenosis is associated with MES and may be its root causes. The presence of MES in VBA stenosis suggests that multiple and embolic type infarctions are the mechanisms of stroke.
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jaechun
authors.initials: J
authors.lastname: Hwang
authors.forename: Suk Jae
authors.initials: SJ
authors.lastname: Kim
authors.forename: Ji Man
authors.initials: JM
authors.lastname: Hong
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Bang
authors.forename: Chin-Sang
authors.initials: CS
authors.lastname: Chung
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Lee
authors.forename: Gyeong-Moon
authors.initials: GM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016001:Confidence Intervals; D003251:Constriction, Pathologic; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D020769:Posterior Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017585:Ultrasonography, Doppler, Transcranial; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology