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Microembolic signals in acute posterior circulation cerebral ischemia: sources and consequences

Authors
Hwang, J; Kim, SJ; Hong, JM; Bang, OY; Chung, CS; Lee, KH; Kim, GM
Citation
Stroke, 43(3):747-752, 2012
Journal Title
Stroke
ISSN
0039-24991524-4628
Abstract
BACKGROUND AND PURPOSE: The clinical significance of microembolic signals (MES) in the posterior circulation remains unclear. The aim of this study was to investigate the sources and consequences of MES in acute posterior circulation cerebral ischemia.



METHODS: We evaluated a total of 140 consecutive patients (93 males, mean age 62.9 years) who had acute posterior circulation cerebral ischemia. The MES monitoring was conducted at the basilar artery through the suboccipital window for a 30-minute period.



RESULTS: MES were detected in 18 (12.9%) of the 140 patients. Clinical characteristics and laboratory data did not differ between the MES-positive and MES-negative groups. Intracranial vertebrobasilar artery (VBA) stenosis was independently associated with the presence of MES (odds ratio, 9.85; 95% confidence interval, 1.22-79.48; P=0.032), whereas the patients with vertebral artery stenosis that was limited to the extracranial portion did not show an association. Microembolic signals occurred significantly more frequently in patients with severe degree of VBA stenosis compared to those with nonsignificant stenosis (odds ratio, 9.88; 95% confidence interval, 1.23-79.07; P=0.031). In a subgroup analysis of the 79 patients who had lesions on diffusion-weighted images and relevant VBA stenosis, the MES-positive group showed more frequent embolic infarction (P=0.010) and multiple lesion patterns (P=0.007) than single perforating infarctions.



CONCLUSIONS: In acute posterior circulation cerebral ischemia, intracranial and severe VBA stenosis is associated with MES and may be its root causes. The presence of MES in VBA stenosis suggests that multiple and embolic type infarctions are the mechanisms of stroke.
MeSH terms
AdultAgedAged, 80 and overBrain Ischemia/*physiopathology/ultrasonographyConfidence IntervalsConstriction, PathologicDiffusion Magnetic Resonance ImagingFemaleHumansImage Processing, Computer-AssistedIntracranial Embolism/*physiopathology/ultrasonographyLogistic ModelsMagnetic Resonance ImagingMaleMiddle AgedOdds RatioPosterior Cerebral Artery/*physiopathology/ultrasonographyProspective StudiesRisk FactorsStroke/*physiopathology/ultrasonographyUltrasonography, Doppler, TranscranialVertebrobasilar Insufficiency/physiopathology/ultrasonography
DOI
10.1161/STROKEAHA.111.633438
PMID
22343653
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Neurology
AJOU Authors
홍, 지만
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