Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Neurol. 2010 Aug;68(2):213-9. doi: 10.1002/ana.22050.
It has been reported that embolic signal (ES) detected by transcranial Doppler (TCD) has clinical significance, especially in patients with recent stroke attributable to arterial or cardiac embolism. Therefore, we conducted this study to determine whether the prevalence of ES is high in ischemic stroke patients with cancer and related to hypercoagulopathy.
We prospectively studied cancer patients with acute ischemic stroke within the middle cerebral artery (MCA) distribution on diffusion-weighted imaging. Conventional stroke mechanisms (CSMs) were determined using cardiologic and vascular studies. Additionally, the coagulation status was assessed based on the serum D-dimer levels, and TCD monitoring was performed on both MCAs for 30 minutes to detect ES. Clinical features including vascular risk factors, characteristics of ischemic stroke, and cancer and laboratory findings associated with the presence of ES were evaluated.
A total of 74 patients were finally included in this study. ES was more commonly observed in patients without CSMs (22 of 38 patients, 57.9%) than in those with CSMs (12 of 36 patients, 33.3%) (p = 0.034). Moreover, ES was more commonly detected in patients with high D-dimer levels (p < 0.001), and D-dimer levels were significantly correlated with the number of ESs in patients without CSMs (r = 0.732, p < 0.001), but were poorly correlated in patients with CSMs (r = 0.152, p = 0.375). Higher levels of D-dimer (odds ratio [OR], 1.082 per 1 microg/ml increase; 95% confidence interval [CI], 1.014-1.154) and adenocarcinoma (OR, 3.829; 95% CI, 1.23-13.052) were independently associated with the presence of ES. The use of anticoagulants dramatically decreased the D-dimer levels.
A high prevalence of ES was observed in cancer patients with ischemic stroke, especially in those without CSMs. Elevated D-dimer levels were independently associated with ES, and decreased dramatically with the use of anticoagulants. ANN NEUROL 2010;68:213-219.
据报道，经颅多普勒（TCD）检测到的栓子信号（ES）具有临床意义，尤其是在归因于动脉或心源性栓塞的近期卒中患者中。因此，我们进行了这项研究，以确定癌症合并缺血性卒中患者中 ES 的发生率是否较高，以及 ES 是否与高凝状态相关。
我们前瞻性地研究了弥散加权成像显示大脑中动脉（MCA）分布区急性缺血性卒中的癌症患者。通过心脏和血管研究确定常规卒中机制（CSM）。此外，基于血清 D-二聚体水平评估凝血状态，并对双侧 MCA 进行 30 分钟的 TCD 监测以检测 ES。评估了与 ES 存在相关的临床特征，包括血管危险因素、缺血性卒中特征、癌症和实验室发现。
本研究最终纳入了 74 例患者。无 CSM 的患者（38 例患者中有 22 例，57.9%）比有 CSM 的患者（36 例患者中有 12 例，33.3%）更常出现 ES（p=0.034）。此外，ES 在 D-二聚体水平较高的患者中更常见（p<0.001），并且 D-二聚体水平与无 CSM 患者的 ES 数量显著相关（r=0.732，p<0.001），但与有 CSM 的患者相关性差（r=0.152，p=0.375）。较高的 D-二聚体水平（比值比[OR]，每增加 1μg/ml 增加 1.082；95%置信区间[CI]，1.014-1.154）和腺癌（OR，3.829；95%CI，1.23-13.052）与 ES 的存在独立相关。抗凝治疗可显著降低 D-二聚体水平。
在缺血性卒中的癌症患者中，ES 的高发生率很常见，尤其是在无 CSM 的患者中。升高的 D-二聚体水平与 ES 独立相关，且在使用抗凝剂后可显著降低。ANN NEUROL 2010；68：213-219。
