Microemboli in patients with vertebrobasilar ischemia

Association with vertebrobasilar and cardiac lesions

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

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background and Purpose: Microembolic high-intensity transient signals (HITS) on transcranial Doppler ultrasound (TCD) are associated with carotid stenosis, artificial heart valves, and other cardiac conditions. Only one case report describes stroke-related HITS in the posterior cerebral circulation. This study was designed to assess prospectively the prevalence of asymptomatic microemboli in vertebrobasilar ischemia and to determine whether potential cardioembolic sources, vertebral or basilar occlusive disease, and infarct subtypes predict the detection of HITS. Methods: We investigated 52 consecutive patients with acute or recent vertebrobasilar ischemia within 48 hours after admission. TCD monitoring was performed according to established criteria for 20 minutes on each posterior cerebral artery. Fetal origin of the posterior cerebral artery was an exclusion criterion and ruled out by carotid compression. Results: Microembolic signals were detected in 10 patients (19.2%). In a multivariate logistic regression analysis that included all independent variables, potential cardiac sources were significantly associated with HITS (odds ratio [OR], 14.3; 95% confidence interval [CI], 1.6 to 128.4), in particular when more than one cardiac abnormality (OR, 32.7; CI, 4.1 to 259.3) or a high-risk source (OR, 14.0; 95% CI, 2.3 to 84.9) was found. Vertebrobasilar vessel lesions and infarct subtype were not related to the detection of microemboli. Conclusions: Cardiac sources of embolism are a determinant of HITS in posterior cerebral circulation ischemia, suggesting that cardioembolic infarcts in that territory might be more common than suspected. Vertebrobasilar vessel abnormalities are less likely to lodge microemboli, which may indicate histopathological changes different from carotid artery disease.

Original languageEnglish
Pages (from-to)593-596
Number of pages4
JournalStroke
Volume28
Issue number3
StatePublished - Mar 1 1997
Externally publishedYes

Fingerprint

Vertebrobasilar Insufficiency
Cerebrovascular Circulation
Posterior Cerebral Artery
Doppler Ultrasonography
Odds Ratio
Confidence Intervals
Artificial Heart
Carotid Artery Diseases
Carotid Stenosis
Heart Valves
Embolism
Brain Ischemia
Logistic Models
Stroke
Regression Analysis

Keywords

  • embolism
  • ultrasonics
  • vertebrobasilar stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Koennecke, H. C., Mast, H., Trocio, S. S., Sacco, R. L., Thompson, J. L. P., & Mohr, J. P. (1997). Microemboli in patients with vertebrobasilar ischemia: Association with vertebrobasilar and cardiac lesions. Stroke, 28(3), 593-596.

Microemboli in patients with vertebrobasilar ischemia : Association with vertebrobasilar and cardiac lesions. / Koennecke, Hans Christian; Mast, Henning; Trocio, Samuel S.; Sacco, Ralph L; Thompson, John L P; Mohr, Jay P.

In: Stroke, Vol. 28, No. 3, 01.03.1997, p. 593-596.

Research output: Contribution to journalArticle

Koennecke, HC, Mast, H, Trocio, SS, Sacco, RL, Thompson, JLP & Mohr, JP 1997, 'Microemboli in patients with vertebrobasilar ischemia: Association with vertebrobasilar and cardiac lesions', Stroke, vol. 28, no. 3, pp. 593-596.
Koennecke HC, Mast H, Trocio SS, Sacco RL, Thompson JLP, Mohr JP. Microemboli in patients with vertebrobasilar ischemia: Association with vertebrobasilar and cardiac lesions. Stroke. 1997 Mar 1;28(3):593-596.
Koennecke, Hans Christian ; Mast, Henning ; Trocio, Samuel S. ; Sacco, Ralph L ; Thompson, John L P ; Mohr, Jay P. / Microemboli in patients with vertebrobasilar ischemia : Association with vertebrobasilar and cardiac lesions. In: Stroke. 1997 ; Vol. 28, No. 3. pp. 593-596.
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abstract = "Background and Purpose: Microembolic high-intensity transient signals (HITS) on transcranial Doppler ultrasound (TCD) are associated with carotid stenosis, artificial heart valves, and other cardiac conditions. Only one case report describes stroke-related HITS in the posterior cerebral circulation. This study was designed to assess prospectively the prevalence of asymptomatic microemboli in vertebrobasilar ischemia and to determine whether potential cardioembolic sources, vertebral or basilar occlusive disease, and infarct subtypes predict the detection of HITS. Methods: We investigated 52 consecutive patients with acute or recent vertebrobasilar ischemia within 48 hours after admission. TCD monitoring was performed according to established criteria for 20 minutes on each posterior cerebral artery. Fetal origin of the posterior cerebral artery was an exclusion criterion and ruled out by carotid compression. Results: Microembolic signals were detected in 10 patients (19.2{\%}). In a multivariate logistic regression analysis that included all independent variables, potential cardiac sources were significantly associated with HITS (odds ratio [OR], 14.3; 95{\%} confidence interval [CI], 1.6 to 128.4), in particular when more than one cardiac abnormality (OR, 32.7; CI, 4.1 to 259.3) or a high-risk source (OR, 14.0; 95{\%} CI, 2.3 to 84.9) was found. Vertebrobasilar vessel lesions and infarct subtype were not related to the detection of microemboli. Conclusions: Cardiac sources of embolism are a determinant of HITS in posterior cerebral circulation ischemia, suggesting that cardioembolic infarcts in that territory might be more common than suspected. Vertebrobasilar vessel abnormalities are less likely to lodge microemboli, which may indicate histopathological changes different from carotid artery disease.",
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AU - Sacco, Ralph L

AU - Thompson, John L P

AU - Mohr, Jay P.

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N2 - Background and Purpose: Microembolic high-intensity transient signals (HITS) on transcranial Doppler ultrasound (TCD) are associated with carotid stenosis, artificial heart valves, and other cardiac conditions. Only one case report describes stroke-related HITS in the posterior cerebral circulation. This study was designed to assess prospectively the prevalence of asymptomatic microemboli in vertebrobasilar ischemia and to determine whether potential cardioembolic sources, vertebral or basilar occlusive disease, and infarct subtypes predict the detection of HITS. Methods: We investigated 52 consecutive patients with acute or recent vertebrobasilar ischemia within 48 hours after admission. TCD monitoring was performed according to established criteria for 20 minutes on each posterior cerebral artery. Fetal origin of the posterior cerebral artery was an exclusion criterion and ruled out by carotid compression. Results: Microembolic signals were detected in 10 patients (19.2%). In a multivariate logistic regression analysis that included all independent variables, potential cardiac sources were significantly associated with HITS (odds ratio [OR], 14.3; 95% confidence interval [CI], 1.6 to 128.4), in particular when more than one cardiac abnormality (OR, 32.7; CI, 4.1 to 259.3) or a high-risk source (OR, 14.0; 95% CI, 2.3 to 84.9) was found. Vertebrobasilar vessel lesions and infarct subtype were not related to the detection of microemboli. Conclusions: Cardiac sources of embolism are a determinant of HITS in posterior cerebral circulation ischemia, suggesting that cardioembolic infarcts in that territory might be more common than suspected. Vertebrobasilar vessel abnormalities are less likely to lodge microemboli, which may indicate histopathological changes different from carotid artery disease.

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