Microembolic Signals Predict Recurrence of Ischemic Events in Symptomatic Patients with Middle Cerebral Artery Stenosis

Middle cerebral artery (MCA) stenosis is a common cause of ischemic stroke in Asian populations. We sought to determine whether microembolic signals (MESs) can predict the occurrence or recurrence of ischemia in symptomatic and asymptomatic patients with MCA stenosis. The symptomatic group had a significantly higher incidence of MES (30% vs. 16.2%, p < 0.05), as well as higher incidences of cerebral infarction and transient ischemic attack (TIA) (infarction, 13.0% vs. 4.4%, OR 3.123 [95% CI, 1.049-9.294], p < 0.05; TIA, 21.0% vs. 2.9%, OR = 7.108 [95% CI, 1.808-27.949], p < 0.001) than the asymptomatic group. After a follow-up period of 0.5-4.5 y, the subgroup of MES-positive (MES+) symptomatic patients had a significantly higher incidence of TIA (36.7% vs. 14.3%, OR = 1.623 [95% CI, 1.166-2.258]; p < 0.001) than the subgroup of MES-negative (MES-) symptomatic patients. The likelihood of the early occurrence of an endpoint event was also higher in the subgroup of MES+ symptomatic patients. In the group of asymptomatic patients with MCA stenosis, no significant differences were identified between the MES+ and MES− subgroups.