Therefore, it seems that embolus

negative patients suffer more from a local thrombosis in relation to cerebral micro-angiopathy than carotid artery macro-angiopathy. However, micro-embolism may still play a role in genesis of micro-angiopathy in embolus negative patients. It is important to realize that TCD cannot detect very tiny embolic particles. The lower limit of TCD embolus detection is approximately about 0.3 mm [12]. The diameter of the origin of the perforating arteries of the brain is around 0.2–0.8 mm [13]. Thus lacunar strokes could be the result of sub 0.3 mm particles which cannot be detected by TCD. The second reason why embolus negative patients may experience an Selleckchem BMS 354825 embolic stroke Linsitinib supplier is that the source of the embolus is located more distal to the TCD sample volume. In this study the sample volume was located around the origin of the MCA, while in lacunar stroke the emboli may for instance arise from unstable microvascular lesions of the perforating arteries which are located both distal and perpendicular to the sample volume. Therefore, the current TCD equipment will not answer the question whether very small emboli can cause lacunar and/or subcortical infarcts. In summary at the HAGA Teaching Hospitals an embolus detection system (EDS) has been developed with a special focus to detect

the short lasting, low

intensity emboli which can be observed in TIA and stroke patients. The EDS can detect embolic activity in patients with a symptomatic carotid stenosis and can be used as a monitor to guard the safety and measure the efficacy of treatment. Reduction of cerebral embolism can be done by a number of interventions. Early prescription of anti-thrombotic drugs, carotid surgery or angioplasty is established means to arrest cerebral embolism. The outcome of the present study shows that with the EDS approach very low recurrence rate can be within range. The stroke recurrence rate at three months for TIA and minor stroke has decreased over the past ten years below the 5% level by the introduction of TIA and stroke services; however, much effort will be needed to achieve a further decrease. To achieve Coproporphyrinogen III oxidase very low stroke recurrence rates (between 0% and 1%), patients need to be seen early after the event, high-risk individuals should be identified rapidly and delivery of anti-thrombotic drug regimes, surgery and angioplasty should be implemented without delay. Randomized clinical studies are needed to evaluate the clinical value of embolus detection in reducing the stroke recurrence rate in TIA and stroke patients. “
“The mortality rate of patients who experience a septic shock and subsequent multi-organ failure is high [1].