Occurrence and clinical impact of microembolic signals (MES) in patients with chronic cardiac diseases and atheroaortic plaques - A systematic review

Current Vascular Pharmacology

Volumn 6, Issue 4, 2008, Pages 329-334

  Dittrich, Ralf ^a   Ringelstein, E Bernd ^a  

^a UNIVERSITY HOSPITAL MÜNSTER   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; ACETYLSALICYLIC ACID PLUS DIPYRIDAMOLE; ARGININE; CLOPIDOGREL; DEXTRAN 40; HEPARIN; PLACEBO; S NITROSOGLUTATHIONE; TICLOPIDINE; TIROFIBAN; CARDIOVASCULAR AGENT;

ACUTE HEART INFARCTION; ADD ON THERAPY; ANTICOAGULATION; ATHEROSCLEROTIC PLAQUE; CARDIOVASCULAR RISK; CEREBROVASCULAR DISEASE; CHRONIC DISEASE; CLINICAL TRIAL; CONGESTIVE CARDIOMYOPATHY; ENDOCARDITIS; HEART ATRIUM FIBRILLATION; HEART DISEASE; HEART SURGERY; HUMAN; LOADING DRUG DOSE; MEDLINE; MITRAL VALVE PROLAPSE; MONITORING; PATENT FORAMEN OVALE; PREVALENCE; REVIEW; SURGICAL TECHNIQUE; SYSTEMATIC REVIEW; THROMBOCYTE ACTIVATION; THROMBOEMBOLISM; THROMBUS; AORTA DISEASE; ATHEROSCLEROSIS; BRAIN EMBOLISM; DOPPLER ECHOGRAPHY; ECHOGRAPHY; RISK FACTOR;

AORTIC DISEASES; ATHEROSCLEROSIS; CARDIOVASCULAR AGENTS; CHRONIC DISEASE; HEART DISEASES; HUMANS; INTRACRANIAL EMBOLISM; RISK FACTORS; ULTRASONOGRAPHY, DOPPLER, TRANSCRANIAL;

EID: 55449138200     PISSN: 15701611     EISSN: None     Source Type: Journal    
DOI: 10.2174/157016108785909797     Document Type: Review

References (71)

1. Spencer MP, Campbell SD, Sealey JL, Henry FC, Lindbergh J. Experiments on decompression bubbles in the circulation using ultrasonic and electromagnetic flowmeters. Occup Med1969; ll: 238-244.
2. Spencer MP, Clarke HF. Precordial monitoring of pulmonary gas embolism and decompression bubbles. Aerosp Med 1972; 43: 762-767.
3. Butler BD, Robinson R, Fife C, Sutton T. Doppler detection of decompression bubbles with computer assisted digitization of ultrasonic signals. Aviat Space Environ Med 1991; 62: 997-1004.
4. Spencer MP, Lawrence GH, Thomas GI, Sauvage LR: The use of ultrasonics in the determination of arterial aeroembolism during open heart surgery. Ann Thorac Surg 1969; 8: 489-497.
5. Padayachee TS, Gosling RG, Bishop CC, Burnand K, Browse NL. Monitoring MCA blood velocity during carotid endarterectomy. Br J Surg 1986; 73: 98-100.
6. Spencer MP, Thomas GI, Nicholls SC, Sauvage LR. Detection of middle cerebral artery emboli during carotid endarterectomy using transcranial Doppler ultrasonography. Stroke 1990; 21: 415-423.
7. Siebler M, Sitzer M, Steinmetz H. Detection of intracranial emboli in patients with symptomatic extracranial carotid artery disease. Stroke 1992; 23: 1652-1654.
8. Markus HS, Droste D, Brown MM. Ultrasonic detection of cerebral emboli in carotid stenosis. Lancet 1993; 341: 1606.
9. Markus HS, Droste DW, Brown MM. Detection of asymptomatic cerebral embolic signals with Doppler ultrasound. Lancet 1994; 343: 1011-1012.
10. Siebler M, Nachtmann A, Sitzer M, Rose G, Kleinschmidt A, Rademacher J, et al. Cerebral microembolism and the risk of ischemia in asymptomatic high-grade internal carotid artery stenosis. Stroke 1995; 26: 2184-2186.
11. Droste DW, Dittrich R, Kemeny V, Schulte-Altedorneburg G, Ringelstein EB. Prevalence and frequency of microembolic signals in 105 patients with extracranial carotid artery occlusive disease. J Neurol Neurosurg Psychiat 1999; 67: 525-528.
12. [No authors listed]. Basic identification criteria of Doppler microembolic signals. Consensus Committee of the Ninth International Cerebral Hemodynamic Symposium. Stroke 1995; 26: 1123.
13. Ringelstein EB, Droste DW, Babikian VL, Evans DH, Grosset DG, Kaps M, et al. Consensus on microembolus detection by TCD. International Consensus Group on Microembolus Detection. Stroke 1998; 29: 725-729.
14. Siebler M, Nachtmann A, Sitzer M, Rose G, Kleinschmidt A, Rademacher J, et al. Cerebral microembolism and the risk of ischemia in asymptomatic high-grade internal carotid artery ischemia. Stroke 1995; 26: 2184-2186.
15. Molloy J, Markus HS. Asymptomatic embolization predicts stroke and TIA risk in patients with carotid artery stenosis. Stroke 1999; 30: 1440-1443.
16. Sliwka U, Job FP, Wissuwa D, Diehl RR, Flachskampf FA, Hanrath P, et al. Occurrence of transcranial Doppler high-intensity transient signals in patients with potential cardiac sources of embolism. A prospective study. Stroke 1995; 26: 2067-2070.
17. Koennecke HC, Mast H, Trocio SS Jr, Sacco RL, Thompson JL, Mohr JP. Microemboli in patients with vertebrobasilar ischemia: association with vertebrobasilar and cardiac lesions. Stroke 1997; 28: 593-596.
18. Poppert H, Sadikovic S, Sander K, Wolf O, Sander D. Embolic Signals in Unselected Stroke Patients: Prevalence and Diagnostic Benefit. Stroke 2006; 37: 2039-2043.
19. Rundek T, Di Tullio MR, Sciacca RR, Titova IV, Mohr JP, Homma S, et al. Association between large aortic arch atheromas and highintensity transient signals in elderly stroke patients. Stroke 1999; 30: 2683-2686.
20. Castellanos M, Serena J, Segura T, Pérez-Ayuso MJ, Silva Y, Dávalos A. Atherosclerotic aortic arch plaques in cryptogenic stroke: a microembolic signal monitoring study. Eur Neurol 2001; 45: 145-150.
21. Schulte-Altedorneburg G, Nam EM, Ritter M, Magyar T, Dittrich R, Csiba L, et al. On the origin of microembolic signals - a clinical and postmortem study. J Neurol 2003; 250: 1044-1049.
22. Kaps M, Hansen J, Weiher M, Tiffert K, Kayser I, Droste DW. Clinically silent microemboli in patients with artificial prosthetic aortic valves are predominately gaseous and not solid. Stroke 1997; 28: 322-325.
23. Droste DW, Hansberg T, Kemeny V, Hammel D, SchulteAltedorneburg G, Nabavi DG, et al. Oxygen inhalation can differentiate gaseous from nongaseous microemboli detected by transcranial Doppler ultrasound. Stroke 1997; 28: 2453-2456.
24. Laas J, Kseibi S, Perthel M, Klingbeil A, El-Ayoubi L, Alken A. Impact of high intensity transient signals on the choice of mechanical aortic valve substitutes. Eur J Cardiothorac Surg 2003; 23: 93-96.
25. Eicke BM, Barth V, Kukowski B, Werner G, Paulus W. Cardiac microembolism: prevalence and clinical outcome. J Neurol Sci 1996; 136: 143-147.
26. Nabavi DG, Arato S, Droste DW, Schulte-Altedorneburg G, Kemeny V, Reinecke H, et al. Microembolic load in asymptomatic patients with cardiac aneurysm, severe ventricular dysfunction, and atrial fibrillation. Clinical and hemorheological correlates. Cerebrovasc Dis 1998; 8: 214-221.
27. Cullinane M, Wainright R, Brown A, Monagahn M, Markus HS. Asymptomatic embolization in subjects with atrial fibrillation not taking Antikoagulants. A prospective Study. Stroke 1998; 29: 1810-1815.
28. Nadareishvili Z, Shoudary Z, Joyner C, Brodie D, Norris JW. Cerebral microembolism in acute myocardial infarction. Stroke 1999; 30: 2679-2682.
29. Georgiadis D, Lindner A, Manz M, Sonntag M, Zunker P, Zerkowski HR, et al. Intracranial microembolic signals in 500 patients with potential cardiac or carotid embolic source and in normal controls. Stroke 1997; 28: 1203-1207.
30. Knappertz VA, Tegeler CH, Furberg CD, Wesley DJ, Stewart KP, Kitzman DW. Carotid Doppler high-intensity transient signals in dilated cardiomyopathy. Am Heart J 2000; 140: E1 4.
31. Baker AJ, Naser B, Benaroia M, Mazer CD. Cerebral microemboli during coronary artery bypass using different cardioplegia techniques. Ann Thorac Surg 1995; 59: 1187-1191.
32. Clark RE, Brillman J, Davis DA, Lovell MR, Price TR, Magovern GJ. Microemboli during coronary artery bypass grafting: genesis and effect on outcome. J Thorac Cardiovasc Surg 1995; 109: 249-258.
33. Sliwka U, Georgiadis D. Clinical correlations of Doppler microembolic signals in patients with prosthetic cardiac valves: analysis of 580 cases. Stroke 1998; 29: 140-143.
34. Nabavi DG, Georgiadis D, Mumme T, Schmid C, Mackay TG, Scheld HH, et al. Clinical relevance of intracranial microembolic signals in patients with left ventricular assist devices: a prospective study. Stroke 1996; 27: 891-896.
35. Potapov EV, Nasseri BA, Loebe M, Kukucka M, Koster A, Kuppe H, et al. Transcranial detection of microembolic signals in patients with a novel nonpulsatile implantable LVAD. ASAIO J 2001; 47: 249-253.
36. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment. Stroke 1993; 24: 35-41.
37. Nabavi DG, Allroggen A, Reinecke H, Schulte-Altedorneburg G, Droste DW, Breithardt G, et al. Absence of circulating microemboli in patients with lone atrial fibrillation. Neurol Res 1999; 21: 566-568.
38. Kumral E, Balkir K, Uzuner N, Evyapan D, Nalbantgil S. Microembolic signal detection in patients with symptomatic and asymptomatic lone atrial fibrillation. Cerebrovasc Dis 2001; 12: 192-196.
39. Ritter M, Dittrich R, Thoenissen N, Ringelstein EB, Nabavi DG. Prevalence and prognostic impact of microembolic signals in arterial sources of embolism. A systematic review of the literature. J Neurol 2008. [Epub ahead of print]
40. Batista P, Oliveira V, Ferro JM. The detection of microembolic signals in patients at risk of recurrent cardioemoblic stroke: possible therapeutical relevance. Cerebrovasc Dis 1999; 9: 314-319.
41. Droste DW, Schlossberg R, Mitusch R, Kaps M. Low frequency of clinically silent circulating emboli in patients with mitral valve prolapse or patent foramen ovale detected by transcranial Doppler ultrasound. Neurol Res 1998; 20: 499-503.
42. Tong DC, Bolger A, Albers GW. Incidence of transcranial Doppler- detected cerebral microemboli in patients referred for echocardiography. Stroke 1994; 25: 2138-2141.
43. Droste DW, Dittrich R, Hermes S, Kemeny V, SchulteAltedorneburg G, Hansberg T, et al. Four-gated transcranial Doppler ultrasound in the detection of circulating microemboli. Eur J Ultrasound 1999; 9: 117-125.
44. Brucher R, Russell D. Automatic online embolus detection and artifact rejection with the first multifrequency transcranial Doppler. Stroke 2002; 33: 1969-1974.
45. Russell D, Brucher R. Online automatic discrimination between solid and gaseous cerebral microemboli with the first multifrequency transcranial Doppler. Stroke 2002; 33: 1975-1980.
46. Cullinane M, Reid G, Dittrich R, Kaposzta Z, Ackerstaff R, Babikian V, et al. Evaluation of new online automated embolic signal detection algorithm, including comparison with panel of international experts. Stroke 2000; 31: 1335-1341.
47. Georgiadis D, Uhlmann F, Astler M, Cencetti S, Zierz S. Automated identification of Doppler microembolic signals: comparison of two techniques. Neurol Res 2000; 22: 738-740.
48. Kemeny V, Droste DW, Hermes S, Nabavi DG, SchulteAltedorneburg G, Siebler M, et al. Automatic embolus detection by a neural network. Stroke 1999; 30: 807-810.
49. Devuyst G, Darbellay GA, Vesin JM, Kemény V, Ritter M, Droste DW, Molina C, Serena J, Sztajzel R, Ruchat P, Lucchesi C, Dietler G, Ringelstein EB, Despland PA, Bogousslavsky J. Automatic classification of HITS into artifacts or solid or gaseous emboli by a wavelet representation combined with dual-gate TCD. Stroke 2001; 32: 2803-2809.
50. Dittrich R, Ritter MA, Kaps M, Siebler M, Lees K, Larrue V, et al. The use of embolic signal detection in multicenter trials to evaluate antiplatelet efficacy: signal analysis and quality control mechanisms in the CARESS (Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic carotid Stenosis) trial. Stroke 2006; 37: 1065-1069.
51. Droste DW, Ringelstein EB. Detection of high intensity transient signals (HITS): how and why? Eur J Ultrasound 1998; 7: 23-29.
52. Georgiadis D, Hill M, Zunker P, Stogbauer F, Ringelstein EB. Anticoagulation monitoring with transcranial Doppler. Lancet 1994; 344: 1373-1374.
53. Markus HS, Thomson ND, Brown MM. Asymptomatic cerebral embolic signals in symptomatic and asymptomatic carotid artery disease. Brain. 1995;118:1005-1011.
54. Sturzenegger M, Beer JH, Rihs F. Monitoring combined antithrombotic treatments in patients with prosthetic heart valves using transcranial Doppler and coagulation markers. Stroke. 1995;26:63-69.
55. Droste DW, Sonne M, Siemens HJ, Kaps M. Asymptomatic circulating cerebral emboli and cerebral blood flow velocity under aspirin and ticlopidine in patients with cerebrovascular disease. Neurol Res. 1996;18:449-453.
56. Droste DW, Siemens HJ, Sonne M, Kaps M, Wagner T. Hemostaseologic and hematologic parameters with aspirin and ticlopidine treatment in patients with cerebrovascular disease: a cross-over study. J Cardiovasc Pharmacol 1996; 28: 591-594.
57. Goertler M, Baeumer M, Kross R, Blaser T, Lutze G, Jost S, et al. Rapid decline of cerebral microemboli of arterial origin after intravenous acetylsalicylic acid. Stroke 1999; 30: 66-69.
58. Goertler M, Blaser T, Krueger S, Lutze G, Wallesch CW. Acetylsalicylic acid and microembolic events detected by transcranial Doppler in symptomatic arterial stenoses. Cerebrovasc Dis 2001; 11: 324-329.
59. Goertler M, Blaser T, Krueger S, Hofmann K, Baeumer M, Wallesch CW. Cessation of embolic signals after antithrombotic prevention is related to reduced risk of recurrent arterioembolic transient ischaemic attack and stroke. J Neurol Neurosurg Psychiat 2002; 72: 338-342. Erratum in: J Neurol Neurosurg Psychiat2002; 73: 102.
60. Esagunde RU, Wong KS, Lee MP, Gan HY, Wong MC, Chang HM, et al. Efficacy of dual antiplatelet therapy in cerebrovascular disease as demonstrated by a decline in microembolic signals. A report of eight cases. Cerebrovasc Dis 2006; 21: 242-246.
61. Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 2005; 111: 2233-2240.
62. Lennard NS, Vijayasekar C, Tiivas C, Chan CW, Higman DJ, Imray CH. Control of emboli in patients with recurrent or crescendo transient ischaemic attacks using preoperative transcranial Doppler-directed Dextran therapy. Br J Surg 2003; 90: 166-70.
63. de Borst GJ, Hilgevoord AA, de Vries JP, van der Mee M, Moll FL, van de Pavoordt HD, et al. Influence of antiplatelet therapy on cerebral micro-emboli after carotid endarterectomy using postoperative transcranial Doppler monitoring. Eur J Vasc Endovasc Surg 2007; 34: 135-142.
64. Molloy J, Martin JF, Baskerville PA, Fraser SC, Markus HS. SNitrosoglutathione reduces the rate of embolization in humans. Circulation 1998; 98: 1372-1375.
65. Kaposzta Z, Baskerville PA, Madge D, Fraser S, Martin JF, Markus HS. L-Arginine and S-nitrosoglutathione reduce embolization in humans. Circulation 2001; 103: 2371-2375.
66. Kaposzta Z, Clifton A, Molloy J, Martin JF, Markus HS. Snitrosoglutathione reduces asymptomatic embolization after carotid angioplasty. Circulation 2002; 106: 3057-3062.
67. Kaposzta Z, Martin JF, Markus HS. Switching off embolization from symptomatic carotid plaque using S-nitrosoglutathione. Circulation 2002; 105: 1480-1484.
68. Junghans U, Siebler M. Cerebral microembolism is blocked by tirofiban, a selective nonpeptide platelet glycoprotein IIb/IIIa receptor antagonist. Circulation 2003; 107: 2717-2721.
69. Tinkler K, Cullinane M, Kaposzta Z, Markus HS. Asymptomatic embolisation in non-valvular atrial fibrillation and its relationship to anticoagulation therapy. Eur J Ultrasound 2002; 15: 21-27.
70. Bendszus M, Koltzenburg M, Bartsch AJ, Goldbrunner R, Günthner-Lengsfeld T, Weilbach FX, et al. Heparin and air filters reduce embolic events caused by intra-arterial cerebral angiography: a prospective, randomized trial. Circulation 2004; 110: 2210-2215.
71. Georgiadis D, Siebler M. Detection of microembolic signals with transcranial Doppler ultrasound. Front Neurol Neurosci 2006; 21: 194-205.