Elsevier

Cardiovascular Surgery

Volume 7, Issue 1, January 1999, Pages 33-38
Cardiovascular Surgery

Microemboli detected by transcranial Doppler monitoring in patients during carotid angioplasty versus carotid endarterectomy

https://doi.org/10.1016/S0967-2109(98)00097-0Get rights and content

Abstract

Microemboli, as detected by transcranial Doppler monitoring, have been shown to be a potential cause of strokes after carotid endarterectomy. We retrospectively reviewed 105 patients who underwent transcranial Doppler monitoring during 112 procedures for the treatment of 115 carotid bifurcation stenoses: 40 by percutaneous angioplasty with stenting and 75 by carotid endarterectomy. In PTAS procedures (n=40), there was a mean of 74.0 emboli per stenosis (range 0–398, P=0.0001) with 4 neurologic events per patient (P=0.08). In CEA procedures (n=76), there was a mean of 8.8. emboli per stenosis (range 0–102, P=0.0001) with 1 neurologic event per patient (P=0.08). The post-procedural neurological events in the percutaneous angioplasty with stenting population included two strokes (5.6%) and two transient ischemia attacks (5.6%). Microemboli for each of these cases totalled 133, 17, 29 and 47 (with one shower), respectively. One postoperative carotid endarterectomy patient was noted to have a stroke (1.4%), with 48 microemboli noted during that procedure. The mean emboli rate for percutaneous angioplasty with stenting patients with neurological events was 59.0: without complications it was 85.1. The mean emboli rate for carotid endarterectomy patients without complications was 8.3. Three percutaneous angioplasty with stenting patients had no emboli (7.5%), whereas 29 carotid endarterectomy patients had no emboli (38.7%). Conclusion: The percutaneous angioplasty with stenting procedure is associated with more than eight times the rate of microemboli seen during carotid endarterectomy when evaluated with transcranial Doppler monitoring. Larger patient groups are needed to determine if this greater embolization rate has an associated risk of higher morbidity or mortality.

Section snippets

Methods

A review was performed of all patients who underwent elective treatment for carotid stenosis by either carotid endarterectomy or percutaneous carotid angioplasty with stenting, and who were monitored by transcranial Doppler from August 1994 through to November 1995 at the University of Alabama at Birmingham Hospital. Intraoperative transcranial Doppler monitoring was done routinely in this carotid endarterectomy population without special patient selection. Intra-procedural transcranial Doppler

Results

From 16 March 1994 to 15 November 1995, 105 of 273 patients (38.5%) underwent transcranial Doppler monitoring during 112 procedures for the treatment of 115 carotid bifurcation stenoses at University Hospital. Percutaneous angioplasty with stenting was performed on 36 patients who underwent 37 procedures for 40 stenoses. Carotid endarterectomy was performed on 69 patients who underwent 75 procedures for 75 stenoses. Eighty-four patients were men (80.0%). The mean age of all patients was 67.2,

Discussion

Carotid balloon angioplasty with or without stent placement has been suggested as an alternative to endarterectomy in the treatment of high-grade stenosis. Our patient series provides a retrospective analysis of the differences in these two techniques, as can be established by transcranial Doppler monitoring. We compared the two treatment modalities with regards to emboli rates and subsequent post-procedure neurological changes.

Transcranial Doppler monitoring has become more common for

Conclusions

Based upon emboli data derived from continuous transcranial Doppler monitoring, percutaneous angioplasty with stenting is associated with a higher embolic risk rate than carotid endarterectomy when used for the treatment of carotid stenosis. Clinical differences were not statistically significant, but a higher neurological complication rate can be expected to be associated with a higher rate of high-intensity transients.

Unlinked references

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