经颅多普勒检测到的微栓塞信号可预测未来中风及不良预后。
Microembolic Signals Detected by Transcranial Doppler Predict Future Stroke and Poor Outcomes.
作者信息
Das Alvin S, Regenhardt Robert W, LaRose Sarah, Monk Andrew D, Castro Pedro M, Sheriff Faheem G, Sorond Farzaneh A, Vaitkevicius Henrikas
机构信息
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
出版信息
J Neuroimaging. 2020 Nov;30(6):882-889. doi: 10.1111/jon.12749. Epub 2020 Jul 10.
BACKGROUND AND PURPOSE
Although transcranial Doppler detects microembolic signals (MES) in numerous settings, the practical significance of such findings remains unclear.
METHODS
Clinical information from ischemic stroke or transient ischemic attack patients (n = 248) who underwent embolic monitoring from January 2015 to December 2018 was obtained.
RESULTS
MES were found in 15% of studies and ischemic recurrence was seen in 11% of patients (over 7 ± 6 days). Patients with MES had more lacunes than those without MES (1 ± 3 vs. 1 ± 2, P = .016), were more likely to have ischemic recurrence (37% vs. 6%, P < .001), undergo a future revascularization procedure (26% vs. 10%, P = .005), have a longer length of stay (9 vs. 4 days, P = .043), and have worse functional disability at discharge (modified Rankin Scale 3-6, 66% vs. 34%, P < .001). After controlling for several relevant cofactors, patients with MES were more likely to have ischemic recurrence (HR 4.90, 95% CI 2.16-11.09, P < .001), worse functional disability (OR 3.31, 95% CI 1.22-8.99, P = .019), and longer length of stays (β = .202, P < .001).
CONCLUSIONS
MES may help to risk stratify patients as their presence is associated with ischemic recurrence and worse outcomes.
背景与目的
尽管经颅多普勒在多种情况下都能检测到微栓子信号（MES），但这些发现的实际意义仍不明确。
方法
获取了2015年1月至2018年12月期间接受栓子监测的缺血性卒中或短暂性脑缺血发作患者（n = 248）的临床信息。
结果
在15%的研究中发现了MES，11%的患者出现了缺血性复发（超过7±6天）。有MES的患者比没有MES的患者有更多的腔隙性梗死（1±3比1±2，P = 0.016），更有可能出现缺血性复发（37%比6%，P < 0.001），接受未来的血管重建手术（26%比10%，P = 0.005），住院时间更长（9天比4天，P = 0.043），出院时功能残疾更严重（改良Rankin量表3 - 6级，66%比34%，P < 0.001）。在控制了几个相关的协变量后，有MES的患者更有可能出现缺血性复发（HR 4.90，95% CI 2.16 - 11.09，P < 0.001），功能残疾更严重（OR 3.31，95% CI 1.22 - 8.99，P = 0.019），住院时间更长（β = 0.202，P < 0.001）。
结论
MES可能有助于对患者进行风险分层，因为其存在与缺血性复发和更差的预后相关。
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