Detection of microemboli in patients with acute ischaemic stroke and atrial fibrillation suggests poor functional outcome.

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY
European Stroke Journal Pub Date : 2024-06-01 Epub Date: 2023-12-27 DOI:10.1177/23969873231220508
Pedro Castro, J Ferreira, Branko Malojcic, Danira Bazadona, Claudio Baracchini, Alessio Pieroni, David Skoloudik, Elsa Azevedo, Manfred Kaps
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Abstract

Introduction: We investigated the burden of microembolic signals (MES) in patients with acute ischaemic stroke (AIS) and atrial fibrillation (AF), assessing their impact on functional outcomes.

Patients and methods: This multicentre international prospective cohort study involved patients with AIS and either a known or newly diagnosed anticoagulant-naïve AF. All centres utilised the same transcranial Doppler machine for 1-h monitoring with bilateral 2 MHz probes within 24 h of symptom onset. Recordings underwent MES analysis by a blinded central reader. The primary objectives were to ascertain the MES proportion and its association with functional outcomes assessed by the modified Rankin scale (mRS) score at 90 days.

Results: Between September 2019 and May 2021, we enrolled 61 patients, with a median age of 78 years (interquartile range 73-83) and a median stroke severity score of 11 (interquartile range 4-18). MES were observed in 14 patients (23%), predominantly unilateral (12/14, 86%), with a median rate of 6 counts/hour (interquartile range 4-18). MES occurrence was higher post-thrombectomy and among those with elevated brain natriuretic peptide levels (p < 0.05). A worse mRS score of 3-6 was more frequent in patients with MES, occurring in 11/14 (79%), compared to those without MES, 20/47 (43%), with an adjusted odds ratio of 5.04 (95% CI, 1.15-39.4), p = 0.04.

Conclusions: Nearly a quarter of patients with AIS and AF exhibited silent microembolization after the index event. Detecting MES within 24 h post-stroke (using transcranial Doppler) could signify a marker of poor functional outcomes. Subsequent trials will assess if very early antithrombotic treatment might enhance outcomes in this highly selective group of cardioembolic stroke patients. (Clinicaltrials.gov ID: NCT06018090).

在急性缺血性脑卒中合并心房颤动的患者中检测到微栓子,表明其功能预后较差。
简介:我们调查了急性缺血性卒中(AIS)和心房颤动(AF)患者体内微栓子信号(MES)的负担,评估其对功能预后的影响:这项多中心国际前瞻性队列研究涉及急性缺血性中风(AIS)和已知或新诊断的抗凝剂无效房颤患者。所有中心均使用同一台经颅多普勒仪,在症状出现后 24 小时内使用双侧 2 MHz 探头进行 1 小时监测。记录由中心盲读员进行 MES 分析。主要目的是确定MES比例及其与90天后通过改良Rankin量表(mRS)评分评估的功能结果之间的关系:在 2019 年 9 月至 2021 年 5 月期间,我们共招募了 61 名患者,中位年龄为 78 岁(四分位距为 73-83 岁),中位卒中严重程度评分为 11 分(四分位距为 4-18 分)。在 14 名患者(23%)中观察到 MES,主要是单侧患者(12/14,86%),中位发生率为 6 次/小时(四分位数范围为 4-18)。血栓切除术后和脑钠肽水平升高的患者发生 MES 的几率更高(P = 0.04):近四分之一的 AIS 和房颤患者在指数事件后出现无声微栓塞。在卒中后 24 小时内检测到微栓塞(使用经颅多普勒)可能是功能预后不良的标志。后续试验将评估早期抗血栓治疗是否能改善这一高选择性心源性栓塞中风患者的预后。(Clinicaltrials.gov ID:NCT06018090)。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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