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Acute Ischemic Stroke Part 10

Tham khảo tài liệu 'acute ischemic stroke part 10', khoa học tự nhiên, công nghệ sinh học phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | Microemboli Monitoring in Ischemic Stroke 151 management. The frequency of microemboli in the presence of intracranial artery stenosis has shown to be associated with the number of infarcts on imaging Wong Gao et al. 2002 . In patients with frequent microemboli dual antiplatelet agents has shown to reduce the frequency of microemboli from intracranial stenosis as in carotid artery stenosis Sebastian Derksen et al. 2011 arguing in favour of using it in those patients. 5.3 Application of microemboli monitoring in heart diseases The clinical and prognostic significance of microemboli in patients with atrial fibrillation and prosthetic valves is unclear. Only few studies have shown that anticoagulation may reduce microembolic frequency in patients with atrial fibrillation Tinkler Cullinane et al. 2002 . It is difficult to choose between anticoagulation versus anti-platelet agents based on the presence or absence of microemboli. However the presence of microemboli may prompt the use either anticoagulation or anti-platelet agents in patients with atrial fibrillation regardless of any thromboembolic events. 5.4 Application of microemboli monitoring in special situations 5.4.1 Arterial dissection As in embolic stroke microemboli are often seen in patients with dissection. More microemboli are present in patients who present with stroke symptoms as opposed to local symptoms Ritter Dittrich et al. 2008 . Presence of microemboli seems to be a predictor of stroke recurrence Molina Alvarez-Sabin et al. 2000 . Microemboli are seen both in dissection of carotid and vertebral arteries and possibly predict thromboembolic events Droste Junker et al. 2001 . Presence of microemboli may be a determining factor in choosing the right medication favoring anticoagulation over antiplatelet agents Engelter Brandt et al. 2007 . 5.4.2 Monitoring during and after carotid endarterectomy Presence of microemboli during carotid endarterectomy is an indicator of new ischemic events Ackerstaff Moons