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Vol. 21, No. 4, 2006
Issue release date: March 2006
Section title: Original Paper
Cerebrovasc Dis 2006;21:242–246
(DOI:10.1159/000091221)

Efficacy of Dual Antiplatelet Therapy in Cerebrovascular Disease as Demonstrated by a Decline in Microembolic Signals

A Report of Eight Cases

Esagunde R.U.b · Wong K.S.c · Lee M.P.a · Gan H.Y.a · Wong M.C.b · Chang H.M.b · Chen C.L.H.b
aNeurovascular Laboratory, and bDepartment of Neurology, Brain Center, National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore; cDepartment of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong, SAR, China

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 4/19/2004
Accepted: 9/20/2005
Published online: 3/17/2006
Issue release date: March 2006

Number of Print Pages: 5
Number of Figures: 0
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Background: The presence of microembolic signals (MES) may indicate an increased risk of recurrent ischemic events in patients with stroke. The optimal management of such patients is uncertain. We report the effect of clopidogrel in addition to aspirin on the number of MES in a series of patients with ischemic stroke and transient ischemic attack (TIA) due to large-vessel disease. Methods: 8 patients with either extracranial or intracranial artery stenosis were identified in 30-min MES studies by transcranial Doppler sonography as having MES. All patients were on antiplatelet therapy prior to baseline transcranial Doppler monitoring. The patients were subsequently treated with clopidogrel in addition to aspirin. Repeat MES studies were performed between day 3 and 7 with aspirin and clopidogrel. Results: All patients were Chinese. The median interval time from symptom onset to initial MES study was 7 days (range of 2–30). MES donor sites included 4 severely stenosed or occluded internal carotid arteries and 4 stenosed middle cerebral arteries. The median MES number at baseline was 8 (range 3–51). Repeat MES studies showed a significant decrease in MES (p = 0.012, Wilcoxon signed ranks test). 4 patients had complete cessation of MES and all patients showed a decline in MES. No patient had recurrent strokes or bleeding complications. Conclusion: The rapid and significant decline of MES in our stroke and TIA patients suggests the possible efficacy of dual antiplatelet therapy with aspirin and clopidogrel in patients with MES and symptomatic large-artery occlusive disease. Randomized controlled trials should be conducted to confirm this preliminary observation.

© 2006 S. Karger AG, Basel


  

Author Contacts

Romulo Urgel Esagunde, MD
Department of Neurology Office, 3rd floor
Jose R. Reyes Memorial Medical Center, San Lazaro Compound
Rizal Avenue, Sta. Cruz, Manila (Philippines)
Tel. +63 2711 9491, ext. 292, Fax +63 2732 1077, E-Mail rhomy24@yahoo.com

  

Article Information

Received: April 19, 2004
Accepted: September 20, 2005
Published online: January 27, 2006
Number of Print Pages : 5
Number of Figures : 0, Number of Tables : 1, Number of References : 27

  

Publication Details

Cerebrovascular Diseases

Vol. 21, No. 4, Year 2006 (Cover Date: March 2006)

Journal Editor: Bogousslavsky, J. (Lausanne)
ISSN: 1015–9770 (print), 1421–9786 (Online)

For additional information: http://www.karger.com/CED


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 4/19/2004
Accepted: 9/20/2005
Published online: 3/17/2006
Issue release date: March 2006

Number of Print Pages: 5
Number of Figures: 0
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


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