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