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(Stroke. 2008;39:503.)
© 2008 American Heart Association, Inc.

Progress Reviews

Occurrence and Clinical Impact of Microembolic Signals During or After Cardiosurgical Procedures

From the Department of Neurology (R.D., E.B.R.) and the Leibniz Institute for Atherosclerosis Research (R.D., E.B.R.), University of Muenster, Muenster, Germany.

Correspondence to Ralf Dittrich, MD, Department of Neurology, University Hospital of Muenster, Albert-Schweitzer-Strasse 33, 48129 Muenster, Germany. E-mail dittrir{at}gmx.de

Background and Purpose— Microembolic signals (MESs) are detectable within the transcranial Doppler frequency spectrum downstream from vascular atherothrombotic or cardiothrombotic lesions. A frequent occurrence of MESs has also been shown during bypass surgery or after mechanical valve implantation. We sought to compile the knowledge on MES prevalence, the clinical impact of these cardiogenic MESs, and microemboli composition.

Summary of Review— We performed a systematic MEDLINE search and summarized the currently available literature about MESs during or after cardiosurgical procedures for this state-of-the-art report.

Conclusions— The nature of cardiogenic MESs is heterogeneous, and their prevalence is highly variable, reflecting their different origin from a broad spectrum of cardiosurgical conditions. The occurrence and number of MESs during cardiac catheterization and percutaneous coronary angioplasty seem to have a clinical impact but need to be explored further. In patients with prosthetic heart valves, in those with left ventricular assist devices, and during cardiac surgery, the occurrence of MESs has an important clinical impact, and MES monitoring has proven its reliability. Although the data encourage intensifying MES detection in cardiac disorders, their heterogeneous nature does not yet allow the use of MESs as a general surrogate parameter for neuronal damage or cardial thromboembolic risk.

Key Words: cardiac embolism • cardiac surgery • cognitive impairment • tcd • transcranial Doppler • ultrasound