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From the Department of Neurology (L.V, V.L., A.P.le T., G.G.) and the
Department of Cardiology (P.M.), Rangueil Hospital, University of Toulouse,
Toulouse, France.
Correspondence to Vincent Larrue, MD. Department of Neurology, Rangueil Hospital, 31403 Toulouse, Cedex 04, France. E-mail larrue.v{at}chu-toulouse.fr
Background and
Purpose—Asymptomatic microembolic
signals (MES) can be demonstrated in patients with cerebral
ischemia using transcranial Doppler (TCD)
ultrasonographic monitoring of the middle cerebral artery. However, the
clinical relevance of MES remains uncertain. The purpose of this study
was to estimate the independent contribution of microembolism to the
risk of early ischemic recurrence (EIR) in patients
with stroke or transient ischemic attack (TIA) of presumed
arterial origin.
Methods—We studied the incidence of EIR in 73 consecutive
patients with carotid stroke or TIA in whom TCD scanning of the
symptomatic middle cerebral artery was performed within 7
days from the onset of symptoms. Patients with a potential cardiac
source of embolism were excluded from the study.
Results—Eight patients had EIR during a mean±SD follow-up of
10±8 days. The incidence of EIR was 4.3 per 100 patient-days in
patients with MES and only 0.5 per 100 patient-days in patients without
MES. The presence of MES was a significant predictor of EIR after
adjustment for the presence of carotid stenosis or aortic arch
atheroma, antiplatelet therapy during follow-up, and
other potential confounding variables (relative risk, 8.7; 95%
confidence interval, 2 to 38.2; P=0.0015).
Conclusions—Microembolism is a significant independent predictor
of EIR in patients with stroke or TIA of presumed arterial
origin.
© 1998 American Heart Association, Inc.
Original Contributions
Microembolic Signals and Risk of Early Recurrence in Patients With Stroke or Transient Ischemic Attack
Key Words: cerebral embolism • risk factors • stroke, acute • ultrasonography
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