Alvin S Das1,2, Robert W Regenhardt2, Sarah LaRose1, Andrew D Monk1, Pedro M Castro3, Faheem G Sheriff4, Farzaneh A Sorond5, Henrikas Vaitkevicius1. 1. Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 2. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 3. Department of Neurology, Centro Hospital Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal. 4. Department of Neurosurgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX. 5. Department of Neurology, Northwestern Memorial Hospital, Feinberg School of Medicine, Chicago, IL.
Abstract
BACKGROUND AND PURPOSE: Although transcranial Doppler detects microembolic signals (MES) in numerous settings, the practical significance of such findings remains unclear. METHODS: Clinical information from ischemic stroke or transient ischemic attack patients (n = 248) who underwent embolic monitoring from January 2015 to December 2018 was obtained. RESULTS: MES were found in 15% of studies and ischemic recurrence was seen in 11% of patients (over 7 ± 6 days). Patients with MES had more lacunes than those without MES (1 ± 3 vs. 1 ± 2, P = .016), were more likely to have ischemic recurrence (37% vs. 6%, P < .001), undergo a future revascularization procedure (26% vs. 10%, P = .005), have a longer length of stay (9 vs. 4 days, P = .043), and have worse functional disability at discharge (modified Rankin Scale 3-6, 66% vs. 34%, P < .001). After controlling for several relevant cofactors, patients with MES were more likely to have ischemic recurrence (HR 4.90, 95% CI 2.16-11.09, P < .001), worse functional disability (OR 3.31, 95% CI 1.22-8.99, P = .019), and longer length of stays (β = .202, P < .001). CONCLUSIONS: MES may help to risk stratify patients as their presence is associated with ischemic recurrence and worse outcomes.
BACKGROUND AND PURPOSE: Although transcranial Doppler detects microembolic signals (MES) in numerous settings, the practical significance of such findings remains unclear. METHODS: Clinical information from ischemic stroke or transient ischemic attack patients (n = 248) who underwent embolic monitoring from January 2015 to December 2018 was obtained. RESULTS: MES were found in 15% of studies and ischemic recurrence was seen in 11% of patients (over 7 ± 6 days). Patients with MES had more lacunes than those without MES (1 ± 3 vs. 1 ± 2, P = .016), were more likely to have ischemic recurrence (37% vs. 6%, P < .001), undergo a future revascularization procedure (26% vs. 10%, P = .005), have a longer length of stay (9 vs. 4 days, P = .043), and have worse functional disability at discharge (modified Rankin Scale 3-6, 66% vs. 34%, P < .001). After controlling for several relevant cofactors, patients with MES were more likely to have ischemic recurrence (HR 4.90, 95% CI 2.16-11.09, P < .001), worse functional disability (OR 3.31, 95% CI 1.22-8.99, P = .019), and longer length of stays (β = .202, P < .001). CONCLUSIONS: MES may help to risk stratify patients as their presence is associated with ischemic recurrence and worse outcomes.
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