Microembolic signal detection in acute ischemic stroke: Clinical relevance and impact on treatment individualization—A narrative review

IF 4.5 2区 医学 Q1 CLINICAL NEUROLOGY
Eleni Bakola, Lina Palaiodimou, Odysseas Kargiotis, Apostolos Safouris, Klearchos Psychogios, Theodoros Karapanayiotides, Christos Moschovos, Vijay K. Sharma, Mark N. Rubin, João Sargento Freitas, Claudio Baracchini, Christos Krogias, Andrei V. Alexandrov, Tsivgoulis Georgios
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引用次数: 0

Abstract

Background

Microembolic signals (MES) can be detected using transcranial Doppler (TCD) ultrasound in several clinical scenarios, including acute ischemic stroke (AIS). This narrative review aims to provide insights into their role in AIS patient management and outcomes.

Methods

The present narrative review consolidates current observational and randomized evidence on the prevalence and clinical relevance of MES in different AIS subtypes and settings.

Results

MES prevalence is higher in AIS patients with large artery atherosclerosis, indicating unstable or vulnerable plaques, and lower in those with small vessel disease. Detecting MES can significantly aid in managing AIS patients, particularly when the cause is unclear, as MES detected in different cerebral arteries can indicate conditions like covert cardioembolism, aortic arch atherosclerosis, or coagulation disorders, including cancer-related stroke. MES are associated with higher risk of stroke recurrence, independently of the underlying stroke mechanism. The detection of MES during and after acute systemic or endovascular reperfusion procedures in large-vessel occlusion patients appears to be predictive of adverse clinical outcomes and recurrent stroke. Finally, a reduction in MES detection may serve as surrogate marker and intermediate endpoint evaluating secondary stroke prevention treatments in the settings of randomized-controlled clinical trials.

Conclusion

MES detection on TCD in AIS remains a useful diagnostic tool as it helps the clinicians to approach the stroke underlying mechanism by detecting and quantifying ongoing cerebral embolization and localizing an embolic source in real time. In addition, it allows monitoring and treatment individualization in stroke patients, while further determining recurrent stroke risk.

Abstract Image

急性缺血性卒中的微栓塞信号检测:临床意义及对个体化治疗的影响--综述
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来源期刊
European Journal of Neurology
European Journal of Neurology 医学-临床神经学
CiteScore
9.70
自引率
2.00%
发文量
418
审稿时长
1 months
期刊介绍: The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).
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