Absence of circulating microemboli in patients with lone atrial fibrillation

Dg, Nabavi; Allroggen, A.; Reinecke, Holger; Schulte-Altedorneburg, Gernot; Dw, Droste; Breithardt, Günter; Eb, Ringelstein

doi:10.1080/01616412.1999.11740977

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…[89][90][91] In contrast, asymptomatic individuals with lone atrial fibrillation very rarely have MES on TCD monitoring, whereas stroke patients with atrial fibrillation and no other risk factors may have a MES detection rate up to 29%. 92,93 Such observations underscore the potential utility of TCD monitoring for the identification of high emboligenic risk patients with atrial fibrillation. Interestingly, a right side propensity of MES detection, attributed possibly to anatomical differences between the innominate and the left common carotid artery, has been reported in a recent study of 30 ischemic stroke patients with atrial fibrillation.…”

Section: Atrial Fibrillationmentioning

confidence: 94%

“…The percentage of patients with NVAF and MES in different studies ranges from 13% to 30%, and the detection is more frequent in cases with previous stroke, insufficient anticoagulation, as well as increased platelet aggregation . In contrast, asymptomatic individuals with lone atrial fibrillation very rarely have MES on TCD monitoring, whereas stroke patients with atrial fibrillation and no other risk factors may have a MES detection rate up to 29% . Such observations underscore the potential utility of TCD monitoring for the identification of high emboligenic risk patients with atrial fibrillation.…”

Section: Cardiac Sourcesmentioning

confidence: 96%

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The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

Kargiotis

Psychogios

Safouris

et al. 2019

Journal of Neuroimaging

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Acute multi‐territory, embolic cerebral infarctions are often associated with serious underlying clinical conditions including the presence of highly “active” emboligenic sources causing that in turn may result in high early recurrence rates. Prompt diagnosis, risk stratification, and treatment are substantial for the prevention of subsequent embolization that would result in further clinical deterioration. Among other clinical investigations, transcranial Doppler (TCD) monitoring is highly efficacious for the detection of microembolic signals (MES) that correspond to microthrombi entering the intracranial circulation. The presence and burden of MES, especially in multiple intracranial arteries, is clearly associated with an increased risk of symptomatic, recurrent embolization, and thus can justify a more aggressive treatment approach (clopidogrel load followed by dual antiplatelet therapy or alternatively therapeutic dose of low‐molecular‐weight heparin). In this narrative review, we discuss the most important causes of multi‐territory embolic ischemic strokes and also underscore the utility of TCD as a noninvasive tool for the diagnosis, risk stratification, and treatment.

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Section: Atrial Fibrillationmentioning

confidence: 94%

Section: Cardiac Sourcesmentioning

confidence: 96%

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

Kargiotis

Psychogios

Safouris

et al. 2019

Journal of Neuroimaging

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“…66,67 However, asymptomatic patients with solely AF rarely exhibit MESs on TCD monitoring. 68,69 Therefore, TCD monitoring holds promise for identifying individuals at high risk of embolism associated with AF. Notably, the prompt initiation of anticoagulation with non-vitamin K antagonist oral anticoagulants can lead to the disappearance of MES.…”

Section: Occult Atrial Fibrillationmentioning

confidence: 99%

The Role of Transcranial Doppler in Patients with Cryptogenic Stroke

Kim,

Park,

et al. 2023

J Neurosonol Neuroimag

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Identifying the stroke mechanism is crucial for secondary prevention of ischemic stroke. However, approximately 20% to 30% of patients with ischemic stroke do not display a discernible cause after standard diagnostic evaluation and are classified as having cryptogenic stroke. Most cryptogenic strokes are believed to be of embolic origin, referred to as embolic stroke of undetermined source. Several potential causes, including occult atrial fibrillation, aortic arch atheroma, non-stenotic atherosclerosis, coagulopathy, and patent foramen ovale (PFO), are significant contributors to cryptogenic stroke. Among these, PFO-associated strokes often manifest as small cortical lesions in the posterior circulation and are associated with fewer traditional risk factors. Ischemic stroke is considered a high risk if there is a large PFO with significant shunting or the presence of an atrial septal aneurysm. Although transesophageal echocardiography is regarded as the gold standard for diagnosing PFO, its invasiveness, high cost, and challenges in certain stroke patients necessitate alternative approaches. Recently, transcranial Doppler (TCD) has emerged as a valuable screening tool for detecting high-risk PFOs, as supported by recent research. Accurate determination of the culprit PFO responsible for ischemic stroke remains crucial for guiding appropriate treatment decisions. This article provides a comprehensive review of the different modalities used to diagnose PFO, strategies for assessing the risk of PFO causing paradoxical embolism, and the role of TCD in patients with cryptogenic stroke caused by other etiologies.

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“…LAF may be a good basis for the study of the role of microembolic signals (MES) in AF, in which concomitant cardiac sources of embolism and most of the risk factors for atherosclerotic disease are absent. A previous study by unilateral transcranial Doppler (TCD) monitoring on LAF patients without stroke did not find MES [4]. The present study was designed to investigate the frequency of MES in LAF patients either with or without stroke.…”

Section: Introductionmentioning

confidence: 99%

Microembolic Signal Detection in Patients with Symptomatic and Asymptomatic Lone Atrial Fibrillation

Kumral

Balkır²,

Uzuner³

et al. 2001

Cerebrovasc Dis

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Background and Purpose: There are few data on the occurrence of microembolic signals (MES) in patients with lone atrial fibrillation (LAF). The aim of this work was to systematically study the frequency of MES in patients with symptomatic and asymptomatic LAF and to compare it with that of nonvalvular atrial fibrillation (NVAF). Methods: 37 consecutive acute stroke patients with LAF, 10 asymptomatic patients with LAF and 100 age-matched healthy controls were studied. Another 92 stroke patients with known NVAF were included in the study to compare patients with LAF regarding the presence of MES. Both middle cerebral arteries were monitored by transcranial Doppler ultrasound for at least 30 min at admission and after 1 week in symptomatic and asymptomatic patients with LAF. All patients with LAF were followed up for a mean duration of 18 months, and recurrent strokes were registered. Results: MES was detected in 11 (29%) symptomatic patients with LAF but only in 1 asymptomatic patient with LAF (χ² = 11.3; p = 0.0008) and in no control subjects (χ² = 106; p = 0.00001). There was no difference in the frequency of MES-positive patients and the number of MES between subjects with symptomatic LAF and known NVAF (29% in both groups; mean count, 16 ± 4 vs. 17 ± 6; p = 0.73). In patients with symptomatic LAF and NVAF who underwent anticoagulant therapy, there was no difference in the frequency of MES after 1 week of hospitalization (χ² = 1.53; p = 0.2). During a mean follow-up period of 18 months, 1 patient with symptomatic LAF and MES had a recurrent ischemic event 1 year after the first stroke and none of those with asymptomatic LAF had any events. Conclusion: Our study suggests that asymptomatic and paroxysmal LAF with a lower frequency of MES is a benign disorder compared to chronic and symptomatic LAF with a higher frequency of MES. Further studies need to justify whether MES has a predictive value in patients with chronic LAF who are prone to ischemic stroke.

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Absence of circulating microemboli in patients with lone atrial fibrillation

Cited by 11 publications

References 17 publications

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

The Role of Transcranial Doppler in Patients with Cryptogenic Stroke

Microembolic Signal Detection in Patients with Symptomatic and Asymptomatic Lone Atrial Fibrillation

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