NDLI: Microembolism versus hemodynamic impairment in rosary-like deep watershed infarcts: a combined positron emission tomography and transcranial Doppler study.

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Microembolism versus hemodynamic impairment in rosary-like deep watershed infarcts: a combined positron emission tomography and transcranial Doppler study.

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Microembolism versus hemodynamic impairment in rosary-like deep watershed infarcts: a combined positron emission tomography and transcranial Doppler study.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Jones, P. Simon Momjian-Mayor, Isabelle Moustafa, Ramez Reda Aigbirhio, Franklin I. Baron, Jean-Claude Fryer, Tim D. Morbelli, Silvia Day, Diana J. Warburton, Elizabeth A.
Description	Country affiliation: United kingdom Author Affiliation: Moustafa RR ( Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK.)
Abstract	BACKGROUND AND PURPOSE: Deep watershed infarcts are frequent in high-grade carotid disease and are thought to result from hemodynamic impairment, particularly when adopting a rosary-like pattern. However, a role for microembolism has also been suggested, though never directly tested. Here, we studied the relationships among microembolic signals (MES) on transcranial Doppler, rosary-like deep watershed infarcts on brain imaging, and cerebral hemodynamic compromise on positron emission tomography (PET), all in severe symptomatic carotid disease. We hypothesized that rosary-like infarcts would be significantly associated with worse hemodynamic status, independent of the presence of MES. METHODS: Sixteen patients with ≥70% carotid disease ipsilateral to recent transient ischemic attack/minor stroke underwent magnetic resonance imaging including diffusion-weighted imaging, (15)O-PET, and transcranial Doppler. Mean transit time, a specific marker for hemodynamic impairment, was obtained in the symptomatic and unaffected hemispheres. RESULTS: Eleven of 16 patients had rosary-like infarcts (Rosary+) and 8 patients had MES. Mean transit time was significantly higher (P=0.008) in Rosary+ patients than in healthy controls (n=10), and prevalence of MES was not different between Rosary+ and Rosary- patients. Contrary to our hypothesis, however, the presence of MES within the Rosary+ subset was associated (P=0.03) with a better hemodynamic status than in their absence, with a significant (P=0.02) negative correlation between mean transit time and rate of MES/h. CONCLUSIONS: Contrary to mainstream understanding, rosary-like infarcts were not independent of presence and rate of MES, suggesting that microembolism plays a role in their pathogenesis, probably in association with hemodynamic impairment. Pending confirmation in a larger sample, these findings have management implications for patients with carotid disease and rosary-like infarcts.
ISSN	00392499
e-ISSN	15244628
Journal	Stroke
Issue Number	11
Volume Number	42
Language	English
Publisher	Lippincott Williams & Wilkins (on behalf of the American Heart Association)
Publisher Date	2011-11-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Cerebral Infarction Diagnosis Hemodynamics Intracranial Embolism Positron-emission Tomography Ultrasonography, Doppler, Transcranial Physiopathology Physiology Prospective Studies Comparative Study Research Support, Non-u.s. Gov't Discipline Cardiology
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine Neuroscience Advanced and Specialized Nursing Neurology (clinical)

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