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Journal of Neurology

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24-08-2022 | Stroke | Original Communication

Microembolic signals and antiplatelet therapy in Moyamoya angiopathy

Authors: Mosche Pompsch, Roland Veltkamp, Rolf R. Diehl, Markus Kraemer

Published in: Journal of Neurology | Issue 12/2022

Abstract

Background

Embolism as a cause of stroke is widely neglected in Moyamoya angiopathy (MMA), and recommendations for use of antiplatelet therapy (APT) vary. We examined the presence of microembolic signals (MES) during transcranial Doppler (TCD) monitoring and assessed the effects of APT on the occurrence of MES in MMA.

Patients and methods

We retrospectively analysed patients with MMA treated at our centre between 2011 and 2021. TCD was performed at first presentation and at most visits, while number of visits varied between individual patients. TCD was performed for 30 min bilaterally. Patient demographics, vascular risk factors, and antiplatelet treatment were collected from each clinic visit and ischemic and haemorrhagic episodes were captured as recorded during follow-up visits.

Results

209 patients were included in the analysis (mean age 38.7 ± 15.3, 28% male). 21 patients with 27 MES-positive TCD examinations were identified (10%). Patient characteristics were similar in MES-positive and MES-negative groups. However, recent ischemic events were detected at a significantly higher rate in MES-positive patients (42.9% vs 4.8%, p < 0.001). After MES detection, change of antiplatelet drug regime was performed, leading to loss of MES in all cases. Dual APT was preferably used in the MES-positive group (p < 0.001) but no significant difference of haemorrhage during follow-up-visits was observed. Reduction of APT before bypass-surgery triggered MES in four patients.

Conclusion

APT is required in patients with MMA. MES monitoring may help to identify risk patients in need of intensified APT.

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Title: Microembolic signals and antiplatelet therapy in Moyamoya angiopathy
Authors: Mosche Pompsch
Roland Veltkamp
Rolf R. Diehl
Markus Kraemer
Publication date: 24-08-2022
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Clopidogrel
Acetylsalicylic Acid
Prasugrel
Acetylsalicylic Acid
Published in: Journal of Neurology / Issue 12/2022
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-022-11323-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Microembolic signals and antiplatelet therapy in Moyamoya angiopathy

Abstract

Background

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

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