Abstract W P102: Emboli Detection Within the Posterior Circulation
Objective: To describe the frequency and clinical significance of microembolic signals in the posterior circulation following acute stroke.
Background: Although transcranial Doppler (TCD) is frequently used in the anterior circulation following ischemic stroke, TCD use for microembolic signal detection (MES) in the posterior circulation has not been validated.
Methods: We retrospectively reviewed all patients who had a TCD performed for a posterior circulation ischemic stroke between 2009-2012. Either the basilar, vertebral or posterior cerebral artery was monitored by TCD for 30 minutes. Characteristics of vessels affected, patient demographics, and occurrence of MES was recorded. Good outcome was defined as discharge home or to an acute rehabilitation facility.
Results: Of the 80 patients (age 61± 15 years, 65% male) who underwent TCD monitoring of the posterior circulation, 22 (27.5%) had MES. The mean number of emboli detected was 1.6 per 30 minutes. Average length of time between symptom onset and TCD was 27 days (outpatient 101.5 days; inpatient 7.3 days). Medical comorbidities were similar in those with and without MES. Vertebral or basilar stenosis >50% was found in 32 patients (40%). Moderate (50-70%) or severe (>70%) stenosis was associated with presence of MES (p=0.002), although the number of MES was similar in those with moderate vs. severe stenosis (p=0.50). Patients with MES were more likely to have experienced a TIA (36.3% vs 12.0%, p=0.01), but not stroke (27.3% vs 29.8%, p= 0.75), prior to the index event. The presence of MES was not associated with time from event to TCD (<7 vs. ≥7 days, p=0.48), length of hospital stay (7 vs. 11 days, p=0.14), recurrent neurologic events while hospitalized (6.7% vs. 12.5%, p=.47) or discharge disposition (15.4% vs. 28.9% with good outcome, p=0.276).
Conclusions: Presence of MES in the posterior circulation is associated with large vessel intracranial stenosis >50% and TIA prior to index event, but does not correlate with a worse clinical outcome. Further studies are needed to establish the utility of TCD monitoring for MES after posterior circulation stroke.
Author Disclosures: S. Cutting: None. F. Cabrera: None. Y. Cabrera: None. N. Campo: None. J. Romano: None. S. Koch: None.
- © 2014 by American Heart Association, Inc.