Embolism to the brain during carotid stenting and surgery

Area of Science:

• Neurology
• Vascular Surgery
• Medical Imaging

Background:

• Carotid bifurcation lesions (>70% stenosis) pose a risk for stroke.
• Carotid endarterectomy (CEA) and carotid stenting (CAS) are common interventions.
• Microembolism (ME) is a potential complication of these procedures.

Purpose of the Study:

• To assess the prevalence and clinical relevance of microembolism in patients undergoing CEA and CAS.
• To compare microembolic events and neurological outcomes between CEA and CAS.
• To evaluate the efficacy of neuroprotective filter devices in CAS.

Main Methods:

• 100 patients (50 CEA, 50 CAS) underwent pre- and post-procedure assessments.
• High-resolution Colour-Flow Mapping (CFM), Transcranial Doppler (TCD), CT/MRI, and psychometric tests were used.
• TCD monitored microembolic events (ME's) intra-operatively and post-operatively.
• Diffusion-weighted MRI (DWI) detected new ischemic brain lesions.
• Psychometric tests evaluated cognitive function.

Main Results:

• CAS procedures (100%) showed significantly more ME's (mean 60) than CEA (74%, mean 5).
• Postoperative DWI revealed new ischemic lesions in 44% of CAS patients versus 4% of CEA patients.
• Cognitive function worsened in 36% of CAS patients compared to 4% of CEA patients.
• Filter protection devices reduced ME's by a mean of 70% during CAS.

Conclusions:

• Mortality and morbidity rates for CAS are comparable to CEA.
• Transcraneal Doppler (TCD) detects more microemboli during endovascular procedures (CAS) than open surgery (CEA).
• Filter devices mitigate ME's in CAS, but cognitive decline is observed in a significant number of patients.