• Antonios Kerasnoudis, Saskia H Meves, Ralf Gold, and Christos Krogias.
• Department of Neurology, Ruhr University, St. Josef-Hospital, Bochum, Germany.
• J Neuroimaging. 2013 Oct 1;23(4):484-8.

Background And PurposeThe detection of microembolic signals in transcranial-Doppler monitoring is associated with a higher stroke risk. We investigated the correlation between the frequency of microembolic signals and the efficacy of the antiplatelet therapy in patients with a recent symptomatic carotid-artery stenosis.Subjects And MethodsThirty-two patients (mean age: 70 years, 22 men) with a recent symptomatic carotid-artery stenosis underwent 30-minute TCD-monitoring. Twenty-three patients received acetylsalicylic-acid and 9 patients clopidogrel as antiplatelet-therapy. At the same day, the antiplatelet effect was measured with multiple-electrode-impedance aggregometry.ResultsIn 20 cases, the qualifying event was a stroke and in 12 cases, a TIA. Twenty-six of the patients had a >50% degree of stenosis. More than one microembolic signals were detected in 13 (40.6%) of the subjects, while multiple-electrode-impedance aggregometry revealed eight low responders (6 acetylsalicylic-acid, 2 clopidogrel). More than one microembolic signals were detected in 6 of the 8 (75.0%) patients with low response, but in only 7 of the 24 subjects (29.2%) with an effective antiplatelet treatment (sensitivity 75%, specificity 70.8%; Fisher's exact test: P = .038).ConclusionsOur study suggests that in patients with recent symptomatic carotid-artery stenosis the detection of more than one microembolic signals might serve as a useful marker for the effectiveness of the antiplatelet treatment.Copyright © 2013 by the American Society of Neuroimaging.

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