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(Stroke. 2006;37:299.)
© 2006 American Heart Association, Inc.

Advances in Stroke 2005

Advances in Neurosonology 2005

From the Stroke Research and Neurosonology Program (A.V.A.), Barrow Neurological Institute, Phoenix, Ariz; and the Stroke Unit (N.M.B.), Ichilov Hospital, Tel Aviv, Israel.

Correspondence to Andrei V. Alexandrov, Stroke Research and Neurosonology Program, Barrow Neurological Institute, Suite 300 Neurology, 500 West Thomas Rd, Phoenix, AZ 85013. E-mail avalexandrov@att.net

Key Words: TPA • ultrasonography, Doppler, transcranial • stroke • thrombolysis • outcomes

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Most notable research with neurovascular ultrasound in 2005 focused on treatment amplification,^1–3 identification of high-risk patients with intracranial stenoses,⁴ increased carotid intima-media thickness,^5,6 monitoring repairs of ascending aorta,⁷ carotid stenting,^8,9 patient selection and outcomes with percutaneous patent foramen ovale closure,¹⁰ and acute stroke treatment.^11–15

Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) was a randomized, double-blind study in subjects with recently symptomatic 50% carotid stenosis. Combination therapy with clopidogrel and aspirin was more effective than aspirin alone in reducing asymptomatic microembolization on transcranial Doppler (TCD) within days of treatment initiation. This controlled trial demonstrated feasibility of TCD emboli detection to evaluate the efficacy of antiplatelet therapy in multicenter studies. Emboli count may become a surrogate marker of stroke risk if validated in future studies,¹⁶ and this technology could potentially be a part of diagnostic work-up to individualize selection of antiplatelets given documented resistance in some patients.¹⁷

Symptomatic intracranial disease remains a global challenge with yet another study showing annual risk of stroke in excess of 12%.⁴ Although ultrasound can be used to identify patients with significant intracranial disease, the challenge remains to find effective secondary prevention strategies.

Preclinical manifestation of high cardiovascular risk can be ascertained with duplex measurement of the intima-media thickness (IMT) in the carotid artery on the neck. Reports demonstrate the ability of IMT to discriminate individuals at low and high 1-year event risk,⁵ and link increased IMT to inflammation as a potential new target in stroke prevention.⁶

TCD provides real-time monitor to . . . [Full Text of this Article]