Detection of microemboli in patients with acute ischaemic stroke and atrial fibrillation suggests poor functional outcome

Data de publicação: 27/12/2023 Data Ahead of Print: 01/12/2023

Autores da FMUP

• Pedro Miguel Araújo Campos De Castro

  Autor

• Elsa Irene Peixoto Azevedo Silva

  Autor

Participantes de fora da FMUP

• Ferreira, J
• Malojcic, B
• Bazadona, D
• Baracchini, C
• Pieroni, A
• Skoloudik, D
• Kaps, M

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Neurociências Clínicas e Saúde Mental

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Introduction: We investigated the burden of microembolic signals (MES) in patients with acute ischaemic stroke (AIS) and atrial fibrillation (AF), assessing their impact on functional outcomes.Patients and methods: This multicentre international prospective cohort study involved patients with AIS and either a known or newly diagnosed anticoagulant-naive AF. All centres utilised the same transcranial Doppler machine for 1-h monitoring with bilateral 2 MHz probes within 24 h of symptom onset. Recordings underwent MES analysis by a blinded central reader. The primary objectives were to ascertain the MES proportion and its association with functional outcomes assessed by the modified Rankin scale (mRS) score at 90 days.Results: Between September 2019 and May 2021, we enrolled 61 patients, with a median age of 78 years (interquartile range 73-83) and a median stroke severity score of 11 (interquartile range 4-18). MES were observed in 14 patients (23%), predominantly unilateral (12/14, 86%), with a median rate of 6 counts/hour (interquartile range 4-18). MES occurrence was higher post-thrombectomy and among those with elevated brain natriuretic peptide levels (p < 0.05). A worse mRS score of 3-6 was more frequent in patients with MES, occurring in 11/14 (79%), compared to those without MES, 20/47 (43%), with an adjusted odds ratio of 5.04 (95% CI, 1.15-39.4), p = 0.04.Conclusions: Nearly a quarter of patients with AIS and AF exhibited silent microembolization after the index event. Detecting MES within 24 h post-stroke (using transcranial Doppler) could signify a marker of poor functional outcomes. Subsequent trials will assess if very early antithrombotic treatment might enhance outcomes in this highly selective group of cardioembolic stroke patients.

Keywords

• Infarction; embolism; atrial fibrillation; ultrasound; transcranial Doppler; Subject terms: ultrasound; ischaemic stroke