Transcranial Doppler as a Predictor of Ischemic Events in Carotid Artery Dissection

Brunser, Alejandro M.; Lavados, Pablo M.; Hoppe, Arnold; Muñoz-Venturelli, Paula; Sujima, Emi; López, J.; Mansilla, Eloy; Cárcamo, Daniel; Díaz, Violeta

doi:10.1111/jon.12379

Cited by 18 publications

(23 citation statements)

References 24 publications

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“…This imaging protocol includes MRA and multicontrast MRI sequences that suppress the signal from adjacent tissue and blood to highlight VW pathologies of both intracranial and extracranial vessels (Figs. [1][2][3][4][5]. 9 This can provide a wealth of new information that timeof-flight (TOF) MRI sequences and other luminal imaging techniques cannot deliver.…”

Section: Vessel Wall Mrimentioning

confidence: 99%

“…4 Transcranial Doppler ultrasonography has also been used in the diagnosis of acute ischemic strokes in the setting of spontaneous cervical arterial dissections. Brunser et al 5 found that the presence of an MES and abnormal vasomotor reactivity, as determined by an abnormal breath hold index, was significantly predictive of a future ischemic event in these patients.…”

mentioning

confidence: 99%

“…It can also aid in evaluating cryptogenic stroke by detecting a patent foramen ovale (PFO) or in identifying emboli in the setting of symptomatic spontaneous dissections. 5,8,20 Whereas these modalities are used primarily to determine the cause of an acute ischemic stroke, 4D CTA and MRA can be more helpful in identifying the true infarct core and potential The evaluation and management of acute ischemic stroke has primarily relied on the use of conventional CT and MRI techniques as well as lumen imaging sequences such as CT angiography (CTA) and MR angiography (MRA). Several newer or less-established imaging modalities, including vessel wall MRI, transcranial Doppler ultrasonography, and 4D CTA and MRA, are being developed to complement conventional CT and MRI techniques.…”

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confidence: 99%

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Advanced imaging in acute ischemic stroke

Kilburg¹,

McNally

Havenon

et al. 2017

FOC

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The evaluation and management of acute ischemic stroke has primarily relied on the use of conventional CT and MRI techniques as well as lumen imaging sequences such as CT angiography (CTA) and MR angiography (MRA). Several newer or less-established imaging modalities, including vessel wall MRI, transcranial Doppler ultrasonography, and 4D CTA and MRA, are being developed to complement conventional CT and MRI techniques. Vessel wall MRI provides high-resolution analysis of both extracranial and intracranial vasculature to help identify previously occult lesions or characteristics of lesions that may portend a worse natural history. Transcranial Doppler ultrasonography can be used in the acute setting as a minimally invasive way of identifying large vessel occlusions or monitoring the response to stroke treatment. It can also be used to assist in the workup for cryptogenic stroke or to diagnose a patent foramen ovale. Four-dimensional CTA and MRA provide a less invasive alternative to digital subtraction angiography to determine the extent of the clot burden and the degree of collateral blood flow in large vessel occlusions. Along with technological advances, these new imaging modalities are improving the diagnosis, workup, and management of acute ischemic stroke— roles that will continue to expand in the future.

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Section: Vessel Wall Mrimentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Advanced imaging in acute ischemic stroke

Kilburg¹,

McNally

Havenon

et al. 2017

FOC

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“…Of patients with symptomatic carotid disease, two had arterial dissection at the time of monitoring by TCD, and in one of these, MES were found. Some other studies have demonstrated the importance of microembolism in TCD monitoring as a risk factor for stroke in carotid dissection [30][31][32]. One of the patients examined in the present study was diagnosed with pulmonary thromboembolism and left-toright shunts could be detected with a simple bubble test, without contrast.…”

Section: Discussionmentioning

confidence: 51%

Relationship of spontaneous microembolic signals to risk stratification, recurrence, severity, and mortality of ischemic stroke: a prospective study

et al. 2020

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Introduction: The presence of microembolic signals (MES) during the acute phase of stroke is poorly understood, and its role and clinical application in relation to risk stratification and prognosis in patients remain uncertain. We assessed the prevalence of spontaneous MES in acute stroke and their relationship with risk stratification, stroke recurrence, morbidity, and mortality. Patients and methods:This was a prospective cohort study conducted in the Stroke Unit. The MES presence was evaluated by transcranial Doppler (TCD) in patients with ischemic stroke within 48 h. The outcomes (risk stratification, morbidity, mortality, and recurrence of a stroke) were followed up for 6 months. The relationship between risk stratification and MES was obtained by odds ratios and that between MES and stroke recurrence, morbidity, and mortality using multiple logistic regression; considering statistical significance at P < 0.05. Results:Of the 111 patients studied, 70 were men (63.1%) and 90 were white (81.1%), with a median age of 68 years. The MES frequency was 7%. There was a significant relationship between MES and symptomatic carotid disease (OR = 22.7; 95% CI 4.1-125.7; P < 0.001), a shorter time to monitoring (OR = 12.4; 95% CI 1.4-105.4; P = 0.02), and stroke recurrence (OR = 16.83; 95% CI 2.01-141; P = .009). Discussion:It was observed that the stroke recurrence adjusted for prior stroke was higher and earlier among patients with MES detection. In conclusion, MES demonstrated a significant correlation with symptomatic carotid disease and a shorter DELAY until monitoring, and could be a predictor for the early recurrence of stroke in the long term.

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“…144 MES have been also detected in individuals with cervical artery dissections and have been associated with the incidence of cerebrovascular events. 145 Aortic dissections, in particular Stanford type A, may be complicated with ischemic stroke. 146 There are currently no published reports of MES in patients with aortic dissection.…”

Section: Aortic Arch Atheroma and Ascending Aortic Dissectionmentioning

confidence: 99%

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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Transcranial Doppler as a Predictor of Ischemic Events in Carotid Artery Dissection

Abstract: TCD can identify a subgroup of patients with CCADW who are at high risk of IE.

Cited by 18 publications

References 24 publications

Advanced imaging in acute ischemic stroke

Advanced imaging in acute ischemic stroke

Relationship of spontaneous microembolic signals to risk stratification, recurrence, severity, and mortality of ischemic stroke: a prospective study

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

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