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Clinical Significance of Microembolic Signal Detection in Acute Ischemic Stroke: Insights Into Ongoing Cerebral Embolization and Occult Etiologies.

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Title: Clinical Significance of Microembolic Signal Detection in Acute Ischemic Stroke: Insights Into Ongoing Cerebral Embolization and Occult Etiologies.
Authors: Bakola, Eleni (AUTHOR), Palaiodimou, Lina (AUTHOR), Theodorou, Aikaterini (AUTHOR), Chondrogianni, Maria (AUTHOR), Papagiannopoulou, Georgia (AUTHOR), Keramida, Anna (AUTHOR), Fanouraki, Stella (AUTHOR), Sterpi, Angeliki‐Erato (AUTHOR), Safouris, Apostolos (AUTHOR), Karapanayiotides, Theodore (AUTHOR), Sargento‐Freitas, João (AUTHOR), Baracchini, Claudio (AUTHOR), Malojčić, Branko (AUTHOR), Bonakis, Anastasios (AUTHOR), Paraskevas, George P. (AUTHOR), Alexandrov, Andrei V. (AUTHOR), Tsivgoulis, Georgios (AUTHOR)
Source: European Journal of Neurology. Mar2026, Vol. 33 Issue 3, p1-12. 12p.
Subjects: Cerebral embolism & thrombosis, Fibrin fragment D, Atrial fibrillation, Ischemic stroke, Stroke patients, Transcranial Doppler ultrasonography
Abstract: Background and Purpose: Transcranial Doppler (TCD) detects microembolic signals (MES), reflecting ongoing cerebral embolization. MES have been studied across stroke subtypes and may clarify etiology, monitor treatment, and predict recurrence. We aimed to determine the prevalence of MES in acute ischemic stroke (AIS), explore clinical and laboratory associations, and assess their role in etiological workup. Methods: We conducted a prospective single‐center study over 3 years including anterior circulation AIS patients within 24 h of onset. Stroke subtype was classified by TOAST criteria. Bilateral middle cerebral artery TCD monitoring was performed for 30 min to detect and quantify MES. Results: Among 136 patients (mean age 60.1 ± 12.4 years), MES were detected in 22 (16.2%; 95% CI: 10.4%–23.5%). MES(+) patients had more often multiple‐territory infarcts (36.4% vs. 10.5%, p = 0.005), newly detected atrial fibrillation (13.6% vs. 0.9%, p = 0.013), and cancer‐associated stroke (18.2% vs. 0.9%, p = 0.002), whereas cryptogenic etiology was less common (18.2% vs. 41.2%, p = 0.041). MES were absent in lacunar stroke. MES positivity correlated with higher D‐dimer levels (median 932 vs. 456 ng/mL, p < 0.001), and MES counts correlated strongly with D‐dimer values (Spearman coefficient: 0.393, p < 0.001). Conclusions: MES were detected in one‐sixth of anterior circulation AIS patients, but were absent in lacunar stroke. Their presence was associated with multiple‐territory infarcts, newly detected atrial fibrillation, and cancer‐related stroke. MES counts correlated with D‐dimer levels, supporting their role as markers of ongoing cerebral embolization and underlying prothrombotic state, with potential utility in revealing occult embolic mechanisms. [ABSTRACT FROM AUTHOR]
Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Label: Title
  Group: Ti
  Data: Clinical Significance of Microembolic Signal Detection in Acute Ischemic Stroke: Insights Into Ongoing Cerebral Embolization and Occult Etiologies.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Bakola%2C+Eleni%22&quot;&gt;Bakola, Eleni&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Palaiodimou%2C+Lina%22&quot;&gt;Palaiodimou, Lina&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Theodorou%2C+Aikaterini%22&quot;&gt;Theodorou, Aikaterini&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Chondrogianni%2C+Maria%22&quot;&gt;Chondrogianni, Maria&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Papagiannopoulou%2C+Georgia%22&quot;&gt;Papagiannopoulou, Georgia&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Keramida%2C+Anna%22&quot;&gt;Keramida, Anna&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Fanouraki%2C+Stella%22&quot;&gt;Fanouraki, Stella&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sterpi%2C+Angeliki‐Erato%22&quot;&gt;Sterpi, Angeliki‐Erato&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Safouris%2C+Apostolos%22&quot;&gt;Safouris, Apostolos&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Karapanayiotides%2C+Theodore%22&quot;&gt;Karapanayiotides, Theodore&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sargento‐Freitas%2C+Jo&#227;o%22&quot;&gt;Sargento‐Freitas, Jo&#227;o&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Baracchini%2C+Claudio%22&quot;&gt;Baracchini, Claudio&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Malojčić%2C+Branko%22&quot;&gt;Malojčić, Branko&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Bonakis%2C+Anastasios%22&quot;&gt;Bonakis, Anastasios&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Paraskevas%2C+George+P%2E%22&quot;&gt;Paraskevas, George P.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Alexandrov%2C+Andrei+V%2E%22&quot;&gt;Alexandrov, Andrei V.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Tsivgoulis%2C+Georgios%22&quot;&gt;Tsivgoulis, Georgios&lt;/searchLink&gt; (AUTHOR)
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22European+Journal+of+Neurology%22&quot;&gt;European Journal of Neurology&lt;/searchLink&gt;. Mar2026, Vol. 33 Issue 3, p1-12. 12p.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Cerebral+embolism+%26+thrombosis%22&quot;&gt;Cerebral embolism &amp; thrombosis&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Fibrin+fragment+D%22&quot;&gt;Fibrin fragment D&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Atrial+fibrillation%22&quot;&gt;Atrial fibrillation&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Ischemic+stroke%22&quot;&gt;Ischemic stroke&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Stroke+patients%22&quot;&gt;Stroke patients&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Transcranial+Doppler+ultrasonography%22&quot;&gt;Transcranial Doppler ultrasonography&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background and Purpose: Transcranial Doppler (TCD) detects microembolic signals (MES), reflecting ongoing cerebral embolization. MES have been studied across stroke subtypes and may clarify etiology, monitor treatment, and predict recurrence. We aimed to determine the prevalence of MES in acute ischemic stroke (AIS), explore clinical and laboratory associations, and assess their role in etiological workup. Methods: We conducted a prospective single‐center study over 3 years including anterior circulation AIS patients within 24 h of onset. Stroke subtype was classified by TOAST criteria. Bilateral middle cerebral artery TCD monitoring was performed for 30 min to detect and quantify MES. Results: Among 136 patients (mean age 60.1 &#177; 12.4 years), MES were detected in 22 (16.2%; 95% CI: 10.4%–23.5%). MES(+) patients had more often multiple‐territory infarcts (36.4% vs. 10.5%, p = 0.005), newly detected atrial fibrillation (13.6% vs. 0.9%, p = 0.013), and cancer‐associated stroke (18.2% vs. 0.9%, p = 0.002), whereas cryptogenic etiology was less common (18.2% vs. 41.2%, p = 0.041). MES were absent in lacunar stroke. MES positivity correlated with higher D‐dimer levels (median 932 vs. 456 ng/mL, p &lt; 0.001), and MES counts correlated strongly with D‐dimer values (Spearman coefficient: 0.393, p &lt; 0.001). Conclusions: MES were detected in one‐sixth of anterior circulation AIS patients, but were absent in lacunar stroke. Their presence was associated with multiple‐territory infarcts, newly detected atrial fibrillation, and cancer‐related stroke. MES counts correlated with D‐dimer levels, supporting their role as markers of ongoing cerebral embolization and underlying prothrombotic state, with potential utility in revealing occult embolic mechanisms. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: &lt;i&gt;Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1111/ene.70550
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        Text: English
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      – SubjectFull: Cerebral embolism & thrombosis
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      – SubjectFull: Fibrin fragment D
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      – SubjectFull: Atrial fibrillation
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      – SubjectFull: Ischemic stroke
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      – SubjectFull: Stroke patients
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      – SubjectFull: Transcranial Doppler ultrasonography
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