Frequency and determinants of microembolic signals on transcranial Doppler in unselected patients with acute carotid territory ischemia. A prospective study

Hans Christian Koennecke, Henning Mast, Samuel H. Trocio, Ralph L Sacco, Weidong Ma, Jay P. Mohr, John L P Thompson

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Background and Purpose: Few data exist regarding to the occurrence of microembolic high-intensity transient signals (HITS) on transcranial Doppler ultrasound (TCD) in unselected acute stroke patients. The aim of this study was to investigate prospectively the frequency and determinants of HITS in acute carotid territory ischemia. We hypothesized that carotid artery disease, cardiac abnormalities, and nonlacunar infarcts were independent predictors of HITS in acute stroke. Methods: We investigated 145 consecutive patients with acute internal carotid artery territory ischemia. The median time interval between stroke and TCD examination was 2 days. TCD monitoring was performed for 30 min on each middle cerebral artery. The frequency of HITS was cross-classified with carotid artery status, potential cardiac sources of embolism, and nonlacunar infarct subtype. Multivariate logistic regression models determined the independent relationship of these variables to HITS. Results: Microembolic signals were detected in 35 patients (24.1%), Ipsilateral carotid artery disease was significantly and independently associated with HITS (odds ratio 3.3, 95% confidence interval 1.4-7.8, p = 0.007), whereas potential cardiac sources (OR 1.07, 95% CI 0.48-2.4, p = 0.84) and infarct subtype (OR 0.84, 95% CI 0.29-2.4, p = 0.75) were not. Conclusions: High-intensity transient signals can be found in almost 25% of patients with acute anterior cerebral circulation ischemia and are significantly more prevalent among those with symptomatic carotid artery disease. Future clinical studies are required to determine whether HITS are a marker of increased stroke recurrence and can help to clarify stroke etiology in patients with competing stroke mechanisms.

Original languageEnglish
Pages (from-to)107-112
Number of pages6
JournalCerebrovascular Diseases
Volume8
Issue number2
DOIs
StatePublished - Mar 1 1998
Externally publishedYes

Fingerprint

Ischemia
Stroke
Prospective Studies
Doppler Ultrasonography
Carotid Artery Diseases
Cerebrovascular Circulation
Logistic Models
Middle Cerebral Artery
Internal Carotid Artery
Embolism
Brain Ischemia
Carotid Arteries
Odds Ratio
Confidence Intervals
Recurrence

Keywords

  • Carotid stenosis
  • Embolism
  • Ischemic stroke
  • Transcranial Doppler

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Frequency and determinants of microembolic signals on transcranial Doppler in unselected patients with acute carotid territory ischemia. A prospective study. / Koennecke, Hans Christian; Mast, Henning; Trocio, Samuel H.; Sacco, Ralph L; Ma, Weidong; Mohr, Jay P.; Thompson, John L P.

In: Cerebrovascular Diseases, Vol. 8, No. 2, 01.03.1998, p. 107-112.

Research output: Contribution to journalArticle

Koennecke, Hans Christian ; Mast, Henning ; Trocio, Samuel H. ; Sacco, Ralph L ; Ma, Weidong ; Mohr, Jay P. ; Thompson, John L P. / Frequency and determinants of microembolic signals on transcranial Doppler in unselected patients with acute carotid territory ischemia. A prospective study. In: Cerebrovascular Diseases. 1998 ; Vol. 8, No. 2. pp. 107-112.
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abstract = "Background and Purpose: Few data exist regarding to the occurrence of microembolic high-intensity transient signals (HITS) on transcranial Doppler ultrasound (TCD) in unselected acute stroke patients. The aim of this study was to investigate prospectively the frequency and determinants of HITS in acute carotid territory ischemia. We hypothesized that carotid artery disease, cardiac abnormalities, and nonlacunar infarcts were independent predictors of HITS in acute stroke. Methods: We investigated 145 consecutive patients with acute internal carotid artery territory ischemia. The median time interval between stroke and TCD examination was 2 days. TCD monitoring was performed for 30 min on each middle cerebral artery. The frequency of HITS was cross-classified with carotid artery status, potential cardiac sources of embolism, and nonlacunar infarct subtype. Multivariate logistic regression models determined the independent relationship of these variables to HITS. Results: Microembolic signals were detected in 35 patients (24.1{\%}), Ipsilateral carotid artery disease was significantly and independently associated with HITS (odds ratio 3.3, 95{\%} confidence interval 1.4-7.8, p = 0.007), whereas potential cardiac sources (OR 1.07, 95{\%} CI 0.48-2.4, p = 0.84) and infarct subtype (OR 0.84, 95{\%} CI 0.29-2.4, p = 0.75) were not. Conclusions: High-intensity transient signals can be found in almost 25{\%} of patients with acute anterior cerebral circulation ischemia and are significantly more prevalent among those with symptomatic carotid artery disease. Future clinical studies are required to determine whether HITS are a marker of increased stroke recurrence and can help to clarify stroke etiology in patients with competing stroke mechanisms.",
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AU - Mohr, Jay P.

AU - Thompson, John L P

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N2 - Background and Purpose: Few data exist regarding to the occurrence of microembolic high-intensity transient signals (HITS) on transcranial Doppler ultrasound (TCD) in unselected acute stroke patients. The aim of this study was to investigate prospectively the frequency and determinants of HITS in acute carotid territory ischemia. We hypothesized that carotid artery disease, cardiac abnormalities, and nonlacunar infarcts were independent predictors of HITS in acute stroke. Methods: We investigated 145 consecutive patients with acute internal carotid artery territory ischemia. The median time interval between stroke and TCD examination was 2 days. TCD monitoring was performed for 30 min on each middle cerebral artery. The frequency of HITS was cross-classified with carotid artery status, potential cardiac sources of embolism, and nonlacunar infarct subtype. Multivariate logistic regression models determined the independent relationship of these variables to HITS. Results: Microembolic signals were detected in 35 patients (24.1%), Ipsilateral carotid artery disease was significantly and independently associated with HITS (odds ratio 3.3, 95% confidence interval 1.4-7.8, p = 0.007), whereas potential cardiac sources (OR 1.07, 95% CI 0.48-2.4, p = 0.84) and infarct subtype (OR 0.84, 95% CI 0.29-2.4, p = 0.75) were not. Conclusions: High-intensity transient signals can be found in almost 25% of patients with acute anterior cerebral circulation ischemia and are significantly more prevalent among those with symptomatic carotid artery disease. Future clinical studies are required to determine whether HITS are a marker of increased stroke recurrence and can help to clarify stroke etiology in patients with competing stroke mechanisms.

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KW - Embolism

KW - Ischemic stroke

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