Malignant Emboli on Transcranial Doppler During Carotid Stenting Predict Postprocedure Diffusion-Weighted Imaging Lesions

• DOI: 10.1161/strokeaha.111.000659
• Publication Date: 2013-03-27T04:54:19Z
• Authors: Mohammed A. Almek...; Andrew M. Demchuk; Sachin Mishra; Simerpreet Bal; Bijoy K. Menon; Samuel Wiebe; Fiona M. Clement; John H. Wong; Michael D. Hill; Mayank Goyal
• Keywords: Transcranial Doppler; Interquartile range; Embolus; Stroke; Carotid stenting

Carotid angioplasty and stenting (CAS) has a higher incidence of periprocedural stroke compared with endarterectomy. Identifying CAS steps the highest likelihood embolization may have important implications. We evaluated safety by correlating findings procedural transcranial Doppler postprocedure diffusion-weighted imaging (DWI) lesions.In this prospective study, monitoring was performed during procedures, which were divided into 11 steps. Embolic signals on counted classified based relative energy index microembolic microemboli ≤ 1 or malignant macroemboli >1. Poststenting MRI in all cases. A negative binomial regression model used to evaluate predictive value emboli for new DWI lesions.Thirty subjects enrolled. Seven 30 (23.3%) asymptomatic. The median embolic signal count 212.5 (108 80 macroemboli). Stent deployment phase showed at 58, followed protection device (P=0.0006). Twenty-four (80%) had lesions post-CAS MRI. 4 (interquartile range 7). Two (6.7%) worsening clinical deficits post-CAS. For every embolus, expected increases 1% ( 95% confidence interval, 0%-2%; P=0.032).We observed high procedure, especially, when devices deployed. Most developed lesions, but only 6.7% deficits. Malignant predicted lesions.