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Plaque surface and microembolic signals in moderate carotid stenosis
G Orlandi1, G Parenti, L Landucci Pellegrini
1Department of Neurosciences, Clinic of Neurology, University of Pisa, Italy.
Abstract:
We performed Transcranial Doppler Monitoring to detect microembolic signals (MES) in 47 patients with moderate (30%-69%) carotid stenosis proven by selective angiography. We compared the occurrence of MES with the clinical characteristics of stenosis (symptomatic or asymptomatic) and the angiographic plaque features (nonulcerated, deep ulceration, superficial ulceration, ulceration with flap, or ulceration without flap). For these cases there was no indication for endarterectomy, nevertheless we thought it would be useful to identify risk subgroups that might benefit from surgical treatment. MES were detected in 17.9% of the stenoses with a prevalence (p <. 01) in symptomatic cases (25%) compared to asymptomatic cases (14. 3%). There was a significant correlation of MES with plaque ulceration (p <.01) and particularly with ulceration without flap (p <.01). No difference between deep and superficial ulceration was observed. The availability of prospective data on this topic might be useful to select subgroups of patients with moderate carotid stenosis at risk for embolism.
Insights
Microembolic signals (MES) were detected in patients with moderate carotid stenosis. MES prevalence was higher in symptomatic cases and correlated with plaque ulceration, particularly ulceration without flap.
Area of Science:
- Neurology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Moderate carotid stenosis poses an embolic risk.
- Identifying high-risk subgroups is crucial for treatment decisions.
Purpose of the Study:
- To investigate the occurrence of microembolic signals (MES) in moderate carotid stenosis.
- To correlate MES with clinical and angiographic plaque features.
Main Methods:
- Transcranial Doppler Monitoring was used to detect MES in 47 patients.
- Patients had moderate (30%-69%) carotid stenosis confirmed by angiography.
- MES occurrence was compared between symptomatic and asymptomatic stenosis and various plaque morphologies.
Main Results:
- MES were detected in 17.9% of stenoses.
- MES prevalence was significantly higher in symptomatic (25%) versus asymptomatic (14.3%) cases (p <.01).
- MES correlated significantly with plaque ulceration (p <.01), especially ulceration without flap (p <.01).
Conclusions:
- MES detection may help identify patients with moderate carotid stenosis at higher embolic risk.
- Plaque ulceration, particularly without flap, is associated with increased MES.
- Prospective data could refine risk stratification for surgical intervention.