Transcranial Doppler monitoring of cerebral embolism in atrial fibrillation and prosthetic valves. Clinical correlations

Anzola, G. P.; Costa, Angelo; Magoni, Mauro; Guindani, M; Cobelli, Milena

doi:10.1111/j.1468-1331.1995.tb00175.x

Cited by 6 publications

(3 citation statements)

References 12 publications

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“…The prevalence of AF and MESs varies between 13% and 30% across different studies, and their detection is more common in patients with a history of stroke, inadequate anticoagulation, or increased platelet aggregation. 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.…”

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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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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“…TCD monitoring captures MES in both symptomatic and asymptomatic individuals with nonvalvular atrial fibrillation (NVAF). 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% .…”

Section: Cardiac Sourcesmentioning

confidence: 99%

“…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. [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.…”

Section: Atrial Fibrillationmentioning

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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