Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
The effect of antithrombotic treatment on cerebral microembolism detected by transcranial Doppler sonography (TCD) in a case of internal carotid artery siphon stenosis is reported. A 58-year-old man suffered acute visual impairment associated with acute transient right upper limb paresis and paresthesia. Ultrasound examination of the neck arteries, TCD and digital subtraction angiography showed stenosis of the siphon of the left internal carotid artery. The patient was administered aspirin as antiplatelet therapy for 40 days, followed by anticoagulant therapy. Subsequently, he experienced many recurrent cerebral ischemic events. TCD monitoring performed on 4 occasions revealed microembolic signals (MES) in the ipsilateral middle cerebral artery. Aspirin was added to anticoagulant therapy. Once the combined anticoagulant and antiplatelet therapy had been introduced, no recurrent events were recorded anymore and no MES were detected. In this case, the detected MES proved to be in close relationship with recurrent cerebral ischemia, and were eliminated by combined anticoagulant and antiplatelet therapy.U radu se izvještava o zapaženom utjecaju antitrombotskog liječenja na cerebralnu mikroemboliju, koji je otkriven transkranijskim Dopplerovim ultrazvukom (TCD) u slučaju stenoze sliva unutarnje karotidne arterije. U 58-godišnjeg muškarca nastupio je akutni poremećaj vida te akutna prolazna pareza i parestezija gornjeg desnog ekstremiteta. Ultrazvučni pregled vratnih arterija, TCD i digitalna subtrakcijska angiografija pokazali su stenozu sliva lijeve unutarnje karotidne arterije. Bolesniku je uvedena antitrombocitna terapija aspirinom kroz 40 dana, nakon čega je nastavio s antikoagulantnom terapijom. Naknadno je imao brojne opetovane moždane ishemijske ispade. Praćenje pomoću TCD provedeno u 4 navrata otkrilo je mikroembolijske signale (MES) u istostranoj središnjoj moždanoj arteriji. Antikoagulantnoj terapiji dodan je aspirin. Nakon što je uvedena kombinirana antikoagulantna i antitrombocitna terapija nisu više zabilježeni nikakvi opetovani ispadi niti su više otkriveni MES. U ovom slučaju se pokazalo da su otkriveni MES bili usko povezani s opetovanom moždanom ishemijom, a uklonjeni su kombiniranom antikoagulantnom i antitrombocitnom terapijom
