Relationship between microemboli in the internal carotid artery and the occurrence of ischemic stroke after transient ischemic attack

Abstract Microembolic signals (MES) have been reported to be an independent risk factor for stroke and transient ischemic attack (TIA). We examined the relationship between MES in the internal carotid artery and the occurrence of ischemic stroke in patients with TIA. A total of 67 patients who had a...

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Bibliographic Details
Published in:Journal of clinical neuroscience 2013-10, Vol.20 (10), p.1366-1370
Main Authors: Liu, Wei-song, Zhu, Shao-fen, Liu, Wei-Feng, Li, Guo-lin, Jiang, Hong-quan
Format: Article
Language:English
Subjects:
Aged
Carotid Artery, Internal - diagnostic imaging
Carotid Artery, Internal - physiopathology
Embolism - diagnostic imaging
Embolism - etiology
Embolism - pathology
Female
Follow-Up Studies
Humans
Internal carotid artery
Ischemic Attack, Transient - complications
Ischemic Attack, Transient - diagnostic imaging
Ischemic stroke
Male
Microemboli
Microembolic signals
Middle Aged
Neurology
Retrospective Studies
Stroke - diagnosis
Stroke - diagnostic imaging
Stroke - etiology
Transcranial Doppler ultrasonography
Transient ischemic attack
Ultrasonography, Doppler, Transcranial
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Summary:Abstract Microembolic signals (MES) have been reported to be an independent risk factor for stroke and transient ischemic attack (TIA). We examined the relationship between MES in the internal carotid artery and the occurrence of ischemic stroke in patients with TIA. A total of 67 patients who had a TIA were examined with transcranial Doppler ultrasonography to detect microemboli in the internal carotid artery 1, 3, and 7 days after admission, and 3 months after discharge. The relationship between the presence of MES and the subsequent occurrence of ischemic stroke was the primary outcome of interest. 35.8% (24/67) of patients were MES(+). During follow-up, ischemic stroke occurred significantly more frequently in patients who were MES(+) compared with patients who were MES(−) (6/24; 25.0% versus 2/43; 4.7%, p = 0.021), as did TIA (11/24; 45.8% versus 4/43; 9.3%). MES(+) status was significantly associated with the occurrence of ischemic stroke after adjusting for age, sex, hypertension, diabetes mellitus, and drug therapy (odds ratio: 8.30; 95% confidence interval: 1.37–50.42; p = 0.021). The positive and negative predictive values of MES status for predicting ischemic stroke were 25.0% and 95.4%, respectively. The presence of microemboli in the internal carotid artery appears to be an important risk factor for the occurrence of ischemic stroke after TIA. The MES(+) rate in patients with transient ischemic attack with severe internal carotid artery stenosis is markedly higher than in patients without internal carotid artery stenosis.
ISSN:0967-5868
1532-2653
DOI:10.1016/j.jocn.2012.11.008