Microembolic Signals Detected by Transcranial Doppler Predict Future Stroke and Poor Outcomes

BACKGROUND AND PURPOSE: Although transcranial Doppler detects microembolic signals (MES) in numerous settings, the practical significance of such findings remains unclear. METHODS: Clinical information from ischemic stroke or transient ischemic attack patients (n = 248) who underwent embolic monitoring from January 2015 to December 2018 was obtained. RESULTS: MES were found in 15% of studies and ischemic recurrence was seen in 11% of patients (over 7 ± 6 days). Patients with MES had more lacunes than those without MES (1 ± 3 vs. 1 ± 2, P =.016), were more likely to have ischemic recurrence (37% vs. 6%, P <.001), undergo a future revascularization procedure (26% vs. 10%, P =.005), have a longer length of stay (9 vs. 4 days, P =.043), and have worse functional disability at discharge (modified Rankin Scale 3-6, 66% vs. 34%, P <.001). After controlling for several relevant cofactors, patients with MES were more likely to have ischemic recurrence (HR 4.90, 95% CI 2.16-11.09, P <.001), worse functional disability (OR 3.31, 95% CI 1.22-8.99, P =.019), and longer length of stays (β =.202, P <.001). CONCLUSIONS: MES may help to risk stratify patients as their presence is associated with ischemic recurrence and worse outcomes.