Lund C, Rygh J, Stensrød B, Sandset P M, Brucher R, Russell D
Department of Neurology, The National Hospital, University of Oslo, Norway.
Cerebrovasc Dis. 2000 Sep-Oct;10(5):403-8. doi: 10.1159/000016097.
OBJECTIVE: The aims of this study were firstly to determine prevalence, frequency, and clinical significance of cerebral microemboli in an unselected acute ischemic stroke population and secondly to examine how this information may improve ischemic stroke subtype classification. METHODS: We intended to perform transcranial Doppler (TCD) microembolus monitorings of the middle cerebral artery (MCA) in the symptomatic hemisphere for 45 min in 120 consecutive patients with internal carotid artery territory ischemia. The first examination was performed within 72 h from start of symptoms and the second 5 +/- 1 days later. Platelet and coagulation system activation were measured following TCD monitoring in 38 patients. The strokes were subtyped using the TOAST classification criteria, and the patients' clinical status was assessed at discharge using the Scandinavian Stroke Scale and the Barthel Index. RESULTS: Microembolus monitoring was technically possible in 83 (69.2%) of the 120 patients. Thirty-two (26.6%) patients had an inadequate temporal bone acoustic window or were too restless to allow long-time monitoring. In 5 (4.2%) patients the relevant MCA was occluded. Twenty-two (26.5%) of the 83 patients had microemboli despite the fact that over 90% were receiving an antiplatelet or an anticoagulant treatment. The mean frequency of microemboli was 6.7 +/- 13.6 per 45 min. Microemboli were more prevalent in assumed cardioembolic stroke than in other subtypes of ischemic stroke (p = 0.047). We found no association between the presence of cerebral microemboli and the clinical outcome or the parameters for platelet or coagulation system activation. The presence of microemboli was not associated with in-hospital deaths (p = 0.17), whereas MCA occlusion was (p = 0.01). CONCLUSIONS: Cerebral microemboli are frequent in unselected acute ischemic stroke patients despite antiplatelet or anticoagulant treatment. TCD detection of microemboli provides valuable pathophysiological information and may, therefore, improve current ischemic stroke subtype classification.
目的：本研究的目的一是确定未选择的急性缺血性卒中人群中脑微栓子的患病率、出现频率及临床意义，二是研究这些信息如何改善缺血性卒中亚型分类。 方法：我们打算对120例连续的颈内动脉供血区缺血患者的症状侧大脑中动脉（MCA）进行45分钟的经颅多普勒（TCD）微栓子监测。首次检查在症状出现后72小时内进行，第二次检查在5±1天后进行。对38例患者在TCD监测后测量血小板和凝血系统激活情况。根据TOAST分类标准对卒中进行亚型分类，并使用斯堪的纳维亚卒中量表和巴氏指数在出院时评估患者的临床状况。 结果：120例患者中有83例（69.2%）在技术上可行微栓子监测。32例（26.6%）患者颞骨气窗不佳或过于躁动，无法进行长时间监测。5例（4.2%）患者相关的MCA闭塞。83例患者中有22例（26.5%）有微栓子，尽管超过90%的患者正在接受抗血小板或抗凝治疗。微栓子的平均出现频率为每45分钟6.7±13.6次。微栓子在假定的心源性栓塞性卒中中比在其他缺血性卒中亚型中更常见（p = 0.047）。我们发现脑微栓子的存在与临床结局或血小板及凝血系统激活参数之间无关联。微栓子的存在与院内死亡无关（p = 0.17），而MCA闭塞与院内死亡有关（p = 0.01）。 结论：在未选择的急性缺血性卒中患者中，尽管进行了抗血小板或抗凝治疗，脑微栓子仍很常见。TCD检测微栓子可提供有价值的病理生理信息，因此可能改善当前的缺血性卒中亚型分类。
Cerebrovasc Dis. 2000
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