Exploration of a zero-tolerance regime on cerebral embolism in symptomatic carotid artery disease

2211-968X/$ — see front matter © 2012 Elsevier GmbH. All rights reserved.

Ruud W.M. Keunena,∗, Agnes van Sonderena, Maayke Hunfelda,
Michael Remmersb, D.L. Tavya, S.F.T.M. de Bruijna, A. Moscha

a Department of Neurology and Clinical Neurophysiology, Haga Teaching Hospitals, The Hague, The Netherlands
b Department of Neurology, Amphia Hospital, Breda, The Netherlands

Background: Current protocols stress the importance of short-term diagnosis and treatmentin recent TIA or minor stroke. The risk of a recurrent event can be predicted with embolus detection. Studies have shown that the presence of micro-emboli is associated with an increased risk of recurrent events. We explored in our patient population the effect of a zero-tolerance regime for cerebral embolism on outcome.
Methods: Patients with a recent TIA or minor stroke were assigned to a study group or control group. Both groups were treated according to European Stroke guidelines, including prompt start of anti-thrombotic therapy, statins and short-term carotid arteries duplex scanning. The
study group was subjected to TCD (Delica 9 series, Shenzen Delicate Electronics Co., LTD.,China)embolus detection as soon as possible (EDS, SMT Medical, Wuerzburg, Germany). If emboli were detected, treatment was started immediately to stop cerebral embolization. This was achieved by either an altered drug regimen (clopidogrel) or angioplasty or carotid endarterectomy within one or two days. If carotid intervention was indicated in the control group, it was performed within two weeks, according to European guidelines.
Results: 133 patients were enrolled in the study with three months follow-up. 61 patients were subjected to the control group, 72 patients were enrolled in the study group. Recurrent events occurred in 10.2% and 3.0%, respectively (p = 0.145).
Conclusion: The current study shows a non-significant reduction in recurrent events in the study group. Probably sample size in this pilot study was insufficient to detect a significant decline.Nevertheless, the results show that embolus detection is feasible and the zero-tolerance regimemay enhance the outcome of TIA and minor stroke patients. The findings support the start of a multicenter randomized trial to assess the clinical value of emboli detection in TIA and stroke care.

研究组接受了TCD(Delica 9系列,深圳市德力凯医疗设备股份有限公司,中国)尽早发现栓子(EDS,SMT Medical,德国维尔茨堡)。如果栓子进行检测后,立即开始治疗以停止脑栓塞。这是通过改变药物治疗方案(氯吡格雷)或血管成形术或颈动脉内膜切除术可以达到一两天内。如果对照组中有颈动脉介入治疗,那就是根据欧洲指南在两周内进行了检查。
结果:133名患者被纳入研究,并进行了三个月的随访。 61例对照组为72例患者。周期性事件发生率分别为10.2%和3.0%(p = 0.145)。

Exploration of a zero-tolerance regime on cerebral embolism in symptomatic carotid artery disease.pdf