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Possible determinants of early microembolism after carotid endarterectomy
Jacinda L Stork1, Christopher R Levi, Brian R Chambers
1National Stroke Research Institute, Austin and Repatriation Medical Centre, West Heidelberg, Victoria 3081, Australia.
Background And Purpose:
High numbers of microembolic signals (MES) have been associated with increased risk of postoperative stroke after carotid endarterectomy (CEA). We sought to identify factors predictive of postoperative MES.
Methods:
Transcranial Doppler monitoring of the ipsilateral middle cerebral artery for MES was performed for 30 minutes during the first postoperative hour in sequential patients undergoing CEA. Stepwise binomial logistic regression analysis was performed to identify preoperative and intraoperative variables that predicted the occurrence of postoperative MES.
Results:
We studied 141 patients (mean age, 69 years); 102 (72%) were male, and 69 (49%) had at least 1 MES (range, 1 to 118) detected in the first postoperative hour. The risk of postoperative MES was greater in women (P=0.027), patients not receiving antiplatelet therapy (P=0.033), and patients undergoing left-sided CEA (P=0.049). Other variables such as residual stenosis seen on completion angiography and operative technique were not associated with postoperative MES.
Conclusions:
Postoperative MES were most likely in women, patients not receiving preoperative antiplatelet therapy, and patients who had a left CEA. Microembolism might explain why these same factors are associated with higher rates of perioperative stroke.
Insights
Women, patients not on antiplatelet therapy, and those undergoing left carotid endarterectomy (CEA) face higher risks of postoperative microembolic signals (MES). These factors may contribute to increased stroke risk after CEA.
Area of Science:
- Cerebrovascular surgery
- Neurology
- Medical monitoring
Background:
- High numbers of microembolic signals (MES) correlate with increased stroke risk post-carotid endarterectomy (CEA).
- Identifying predictors of postoperative MES is crucial for stroke prevention strategies.
Purpose of the Study:
- To determine preoperative and intraoperative factors that predict the occurrence of postoperative MES following CEA.
Main Methods:
- Transcranial Doppler (TCD) monitoring of the middle cerebral artery for MES was conducted for 30 minutes in the first postoperative hour.
- Stepwise binomial logistic regression analysis identified predictive variables.
Main Results:
- Of 141 patients, 69 (49%) had detected MES.
- Postoperative MES risk was higher in women (P=0.027), patients not on antiplatelet therapy (P=0.033), and those undergoing left-sided CEA (P=0.049).
- Residual stenosis and operative technique did not predict MES.
Conclusions:
- Women, patients not receiving preoperative antiplatelet therapy, and those undergoing left CEA are most likely to experience postoperative MES.
- These findings suggest microembolism may underlie the association between these factors and higher perioperative stroke rates.