Microembolic signal monitoring and the prediction of thromboembolic events following coil embolization of unruptured intracranial aneurysms: diffusion-weighted imaging correlation.

INTRODUCTION: Microembolic signal (MES) monitoring with transcranial Doppler ultrasonography (TCD) may allow for early prediction of thromboembolisms following endovascular coiling of unruptured intracranial aneurysms (UIAs). However, the method has not gained widespread use and may benefit from correlation with diffusion-weighted imaging (DWI) of acute ischemic lesions after coiling. This purposed to evaluate the relationship between MESs and DWI-positive lesions more precisely.
METHODS: We conducted a prospective study on 45 consecutive patients. TCD was performed over the artery that is dependent on the site of aneurysm, but seven patients (15.6%) could not be examined due to the lack of an adequate cranial window. Consequently, 38 patients were available to detect MESs immediately (MES-1) and 24 h (MES-2) after coiling for UIAs. We also checked DWI 1 day after the coiling and analyzed correlations between the TCD and DWI findings.
RESULTS: MES-1 and MES-2 were positive in 25 (65.7%) and 14 (36.8%) patients, respectively. DWI-positive lesions were seen in 20 (52.6%) patients, and only 1 (2.6%) patient was symptomatic. MES-1 and MES-2 were strongly correlated with the number of DWI-positive lesions (Spearman's correlation coefficient = 0.79 and 0.70, P < 0.01 and P < 0.01, respectively). Additionally, there was a significant correlation between MES-1 and MES-2 (Spearman's correlation coefficient = 0.70).
CONCLUSION: Based upon the significant correlation between MES and DWI findings, MES may have a role for early detection of ischemic complications after coiling of UIAs. In addition, future study for further validation with clinical application seems requiring.