Abstract 4421: Cerebral Microembolization During Carotid Endarterectomy versus Carotid Stenting Using Transcranial Doppler Monitoring
Backgrounds and Purpose: Despite the low incidence of clinically significant cerebral infarcts during carotid interventions, asymptomatic microemboli to the brain may remain high. Recent data suggests that these “silent infarcts” to the brain may have significant long-term clinical implications leading to “vascular dementia”. The goal of our study was to evaluate the incidence of microembolic debris reaching the brain comparing two standard carotid revascularization techniques.
Methods: We performed bilateral Transcranial Doppler (TCD) exams during carotid stenting (CAS) and ipsilateral TCD during carotid endarterectomy (CEA) on 28 procedures in a multi speciality practice to determine intra-procedural patterns of microembolic signals (MES). 28 procedures (15 CAS, 13 CEA) were prospectively monitored by TCD at an academic center over a 7-month period with 30-day clinical follow up.
Results: Procedural and insonation success was possible in 10 CAS and 12 CEA performed in 21 patients. One patient has bilateral staged CEA. Insonation failure due to poor windows occurred in 5 patients (17.8%, 4 CAS, 1 CEA). An additional patient failed CAS, and underwent subsequent CEA without TCD monitoring. The median ipsilateral MES rate was 7.5(range 0 to 77, SD 21) and 338.5 (range 151 to 432, SD 98.1), during CEA and CAS (p<0.005). The median contralateral MES rate during CAS was 80 (range 14 to 282, SD 80). There were no clinically evident post-procedural strokes or transient ischemic attacks in any of the study patients.
Conclusions: Despite technological advances and embolic protection device utilization, the rate of MES during CAS remains high. Additionally, contralateral emboli are procedurally unique to CAS and occur at a significant rate. Further studies to evaluate the significance of these MES and to refine intraoperative techniques to minimize MES are warranted.