Stroke, Vol 24, 1-5, Copyright © 1993 by American Heart Association
HS Markus and MM Brown
BACKGROUND AND PURPOSE: The detection of circulating particulate cerebral
emboli using transcranial Doppler ultrasonography has been recently
reported. It has been suggested that this method might allow discrimination
between different embolic materials; this would be very useful for
selecting specific pharmacological treatment in individual patients. This
study was designed to identify those parameters of the Doppler signal that
might prove useful in discriminating between different types and sizes of
particulate cerebral emboli. METHODS: An extracorporeal circuit filled with
a saline/Tween solution and driven by a peristaltic pump was used. The
tubing was placed in a skull in the position of the middle cerebral artery.
Using transcranial Doppler ultrasound, flow was insonated via the
transtemporal window. The following embolic materials of measured sizes
(range of maximum dimension, 0.5-5.0 mm) were introduced into the circuit:
thrombus (n = 20), platelet-rich aggregates (n = 15), atheromatous material
(n = 20), and fat (n = 20). The Doppler signal was recorded during the
passage of each embolus. Off-line analysis was performed to measure the
maximum amplitude and duration of the signal. RESULTS: For all embolic
materials there was a highly significant relation between embolus size and
maximum amplitude of the Doppler signal. The closest correlation was
obtained when the logarithm of maximum amplitude was used (for thrombi, r =
0.74; for platelet, r = 0.87; for atheroma, r = 0.46; and for fat, r =
0.68). The slope of the regression line differed for the different embolic
materials and was significantly steeper for platelets than for atheroma (p
< 0.01). Platelet emboli of maximum dimension < or = 1.5 mm resulted
in a significantly lower maximum amplitude than similarly sized atheroma
emboli (157 dB versus 206.7 dB, p < 0.01). For larger emboli (> 2 mm)
there was little further increase in maximum amplitude with increases in
embolus size. For all embolic materials there was a highly significant
linear relation between embolus size and duration of the high-amplitude
(> 150 dB) signal (for thrombi, r = 0.75; for platelet, r = 0.90; for
atheroma, r = 0.77; and for fat, r = 0.86). CONCLUSIONS: Platelet emboli
result in lower-amplitude signals, and therefore analysis of maximum
amplitude may provide information on the type of embolic material. However,
it may be difficult to determine whether a given signal is associated with
a large platelet embolus or a small atheroma embolus. Duration of the
high-amplitude signal will allow accurate estimation of the size of emboli,
particularly where the emboli are all of the same material.
ARTICLES
Differentiation between different pathological cerebral embolic materials using transcranial Doppler in an in vitro model [published erratum appears in Stroke 1993 Jun;24(6):913]
Division of Clinical Neuroscience, St. George's Hospital Medical School, London, UK.
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S. Mui, M. Briggs, H. Chung, R. B. Wallace, T. Gomez-Isla, G. W. Rebeck, and B. T. Hyman A newly identified polymorphism in the apolipoprotein E enhancer gene region is associated with Alzheimer's disease and strongly with the epsilon 4 allele Neurology, July 1, 1996; 47(1): 196 - 201. [Abstract] [Full Text] [PDF]
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J. Bogousslavsky, S. Garazi, X. Jeanrenaud, N. Aebischer, G. Van Melle, and For the Lausanne Stroke with Paradoxal Embolism St Stroke recurrence in patients with patent foramen ovale: The Lausanne Study Neurology, May 1, 1996; 46(5): 1301 - 1301. [Abstract] [Full Text] [PDF]
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P. H. Davis, Clarke W.R. PhD, B.H. Bendixen, H.P. Adams Jr., R. F. Woolson, A. Culebras, and the TOAST investigators. Silent cerebral infarction in patients enrolled in the TOAST study Neurology, April 1, 1996; 46(4): 942 - 948. [Abstract] [Full Text] [PDF]
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A.M. Forteza, V.L. Babikian, C. Hyde, M. Winter, and V. Pochay Effect of Time and Cerebrovascular Symptoms on the Prevalence of Microembolic Signals in Patients With Cervical Carotid Stenosis Stroke, April 1, 1996; 27(4): 687 - 690. [Abstract] [Full Text]
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B. Mokri, P. L. Silbert, W. I. Schievink, and D. G. Piepgras Cranial nerve palsy in spontaneous dissection of the extracranial internal carotid artery Neurology, February 1, 1996; 46(2): 356 - 359. [Abstract] [Full Text] [PDF]
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A. Chamorro, N. Vila, A. Saiz, M. Alday, and E. Tolosa Reply from the Author: Safety of heparin in acute ischemic stroke Neurology, February 1, 1996; 46(2): 589 - 591. [Full Text] [PDF]
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D. Barbut, F.S. Yao, D.N. Hager, P. Kavanaugh, R.R. Trifiletti, and J.P. Gold Comparison of Transcranial Doppler Ultrasonography and Transesophageal Echocardiography to Monitor Emboli During Coronary Artery Bypass Surgery Stroke, January 1, 1996; 27(1): 87 - 90. [Abstract] [Full Text]
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F. P. Sarasin, H. Bounameaux, and J. Bogousslavsky Asymptomatic severe carotid stenosis: Immediate surgery or watchful waiting? A decision analysis Neurology, December 1, 1995; 45(12): 2147 - 2153. [Abstract] [Full Text] [PDF]
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J. L. Smith, D. H. Evans, L. Fan, M. E. Gaunt, N. J.M. London, P. R.F. Bell, and A. R. Naylor Interpretation of Embolic Phenomena During Carotid Endarterectomy Stroke, December 1, 1995; 26(12): 2281 - 2284. [Abstract] [Full Text]
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H. Markus Importance of Time-Window Overlap in the Detection and Analysis of Embolic Signals Stroke, November 1, 1995; 26(11): 2044 - 2047. [Abstract] [Full Text]
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U. Sliwka, F.-P. Job, D. Wissuwa, R. R. Diehl, F.-A. Flachskampf, P. Hanrath, and J. Noth Occurrence of Transcranial Doppler High-Intensity Transient Signals in Patients With Potential Cardiac Sources of Embolism : A Prospective Study Stroke, November 1, 1995; 26(11): 2067 - 2070. [Abstract] [Full Text]
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M. Silvestrini, E. Troisi, M. Matteis, L. M. Cupini, and C. Caltagirone Involvement of the healthy hemisphere in recovery from aphasia and motor deficit in patients with cortical ischemic infarction: A transcranial Doppler study Neurology, October 1, 1995; 45(10): 1815 - 1820. [Abstract] [Full Text] [PDF]
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H. S. Markus and M. J. Harrison Microembolic Signal Detection Using Ultrasound Stroke, September 1, 1995; 26(9): 1517 - 1519. [Full Text]
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D. C. Tong and G. W. Albers Transcranial Doppler–Detected Microemboli in Patients With Acute Stroke Stroke, September 1, 1995; 26(9): 1588 - 1592. [Abstract] [Full Text]
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D. Charletta, P.B. Gorelick, T.J. Dollear, S. Freels, and Y. Harris CT and MRI findings among African-Americans with Alzheimer's disease, vascular dementia, and stroke without dementia Neurology, August 1, 1995; 45(8): 1456 - 1461. [Abstract] [Full Text] [PDF]
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P. L. Silbert, B. Mokri, and W. I. Schievink Headache and neck pain in spontaneous internal carotid and vertebral artery dissections Neurology, August 1, 1995; 45(8): 1517 - 1522. [Abstract] [Full Text] [PDF]
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Basic Identification Criteria of Doppler Microembolic Signals Stroke, June 1, 1995; 26(6): 1123 - 1123. [Full Text]
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L. Valton, V. Larrue, P. Arrue, G. Geraud, and A. Bes Asymptomatic Cerebral Embolic Signals in Patients With Carotid Stenosis : Correlation With Appearance of Plaque Ulceration on Angiography Stroke, May 1, 1995; 26(5): 813 - 815. [Abstract] [Full Text]
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L. R. Caplan Binswanger's disease--revisited Neurology, April 1, 1995; 45(4): 626 - 633. [Full Text] [PDF]
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M. Sturzenegger, H. P. Mattle, A. Rivoir, and R. W. Baumgartner Ultrasound findings in carotid artery dissection: Analysis of 43 Patients Neurology, April 1, 1995; 45(4): 691 - 698. [Abstract] [Full Text] [PDF]
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R. E. Clark, J. Brillman, D. A. Davis, M. R. Lovell, T. R. P. Price, and G. J. Magovern MD Microemboli during coronary artery bypass grafting: Genesis and effect on outcome J. Thorac. Cardiovasc. Surg., February 1, 1995; 109(2): 249 - 258. [Abstract] [Full Text]
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E. V. van Zuilen, F. L. Moll, F. E.E. Vermeulen, H. W. Mauser, J. van Gijn, and R. G.A. Ackerstaff Detection of Cerebral Microemboli by Means of Transcranial Doppler Monitoring Before and After Carotid Endarterectomy Stroke, February 1, 1995; 26(2): 210 - 213. [Abstract] [Full Text]
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Z. Kaposzta, J. F. Martin, and H. S. Markus Switching off Embolization From Symptomatic Carotid Plaque Using S-Nitrosoglutathione Circulation, March 26, 2002; 105(12): 1480 - 1484. [Abstract] [Full Text] [PDF]
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