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Microembolic signals at 48 hours of stroke onset contribute to new ischemia within a week
  1. Yasuyuki Iguchi (yigu{at}med.kawasaki-m.ac.jp)
  1. Kawasaki Medical School, Japan
    1. Kazumi Kimura
    1. Kawasaki Meidical School, Japan
      1. Kazuto Kobayashi
      1. Kawasaki Medical School, Japan
        1. Yuji Ueno
        1. Kawasaki Medical School, Japan
          1. Kensaku Shibazaki
          1. Kawasaki Medical School, Japan
            1. Takeshi Inoue
            1. Kawasaki Medical School, Japan

              Abstract

              Backgrounds and Purpose: We investigated whether new ischemic lesions (NIL) on follow-up diffusion-weighted magnetic resonance imaging (DWI) are associated with microembolic signals (MES) within 24 h or at 48 h after stroke onset.

              Methods: Subjects were acute ischemic stroke patients within 24 h of onset. TCD was prospectively examined twice, within 24 h and at 48 h after onset. DWI were conducted twice, on admission and at day 7. NIL was defined as the presence of hyper-intense lesions undetected on initial DWI.

              Results: Subjects comprised 125 patients consecutively enrolled from November 2004 to March 2006. TCD detected MES in 49% within 24 h and 29 % at 48 h after onset. In 27 patients with small vessel disease, MES were found in 8 (30%) patients within 24 h and 5 (19%) at 48 h of stroke onset. On the other hand, in 20 patients with large vessel disease, 11 (55%) patients within 24 h and 7 (35%) at 48 h had MES. Follow-up DWI detected NIL in 28 of 125 patients (22%) and NIL was significantly more frequent in MES-positive patients (42%) than in MES-negative patients at 48 h (15%; p=0.002). MES at 48 h (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.5-10; p=0.005), atrial fibrillation (OR, 3.6; 95%CI, 1.3-11; p=0.013), and arterial lesion (OR, 4.3; 95%CI, 1.5-12; p=0.007) represented independent factors of NIL.

              Conclusion: Presence of MES at 48 h, atrial fibrillation and arterial lesions are associated with recurrence of cerebral ischemia on DWI.

              • cerebral infarct
              • diffusion-weighted imaging
              • ischemic lesion
              • microembolic signals
              • transcranial doppler

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