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Microembolic signals predict cerebral ischaemic events in patients with moyamoya disease
Author(s) -
Chen J.,
Duan L.,
Xu W.H.,
Han Y.Q.,
Cui L.Y.,
Gao S.
Publication year - 2014
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12392
Subject(s) - moyamoya disease , medicine , transcranial doppler , cardiology , ischaemic stroke , stroke (engine) , hazard ratio , middle cerebral artery , revascularization , ischemia , confidence interval , mechanical engineering , engineering , myocardial infarction
Background and purpose Recent studies found that microembolic signals ( MES s) could be detected by transcranial Doppler in patients with moyamoya disease. However, the clinical significance of MES s in moyamoya disease remains unclear. Our aim was to investigate whether the MES s could predict cerebral ischaemic events in patients with moyamoya disease. Methods Fifty‐four consecutive patients with moyamoya disease were recruited. MES s were monitored by transcranial Doppler for 30 min in the bilateral middle cerebral arteries of each patient on admission. Patients were followed up for 1 year. The primary end‐point was cerebral ischaemic events including stroke and transient ischaemic attack ( TIA ). Results MES s were detected in 11 (20.4%) patients, with a frequency of 11 (10.2%) in 108 hemispheres. Logistic regression analysis revealed that previous ischaemic events within 3 months were associated with the presence of MES s (odds ratio 4.41, 95% CI 1.11–17.59). During a median follow‐up of 384 days, 14 (13.0%) hemispheres had ischaemic events (seven strokes and seven TIA s). Cox regression showed that the hazard ratio for the risk of new ischaemic stroke and TIA in the hemispheres with MES s was 6.84 (95% CI 1.82–25.66) compared with those without, and 10.61 (95% CI 1.66–67.70) for ischaemic stroke alone, after controlling for age, sex, presence of ischaemic events at baseline, Suzuki stages and revascularization surgery. Conclusions In patients with moyamoya disease, the presence of MES s is associated with recent ischaemic symptoms and independently predicts cerebral ischaemic events. MES detection may be of potential clinical value in the management of patients with moyamoya disease.