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Published on: September 25, 2016
Symptomatic Carotid Occlusion Is Frequently Associated With Microembolization
Ava L Liberman1, Ali Zandieh2, Caitlin Loomis2
1From the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.). avliberm@montefiore.org.
Microembolic signals (MES) are common in symptomatic carotid artery disease, indicating cerebral embolization is key in both stenosis and occlusion. Further research into aggressive therapies for carotid occlusions is warranted.
Area of Science:
- Neurology
- Vascular Surgery
- Cerebrovascular Disease
Background:
- Symptomatic carotid artery disease presents significant risks for morbidity and mortality.
- Pathophysiologic mechanisms of cerebral ischemia in carotid occlusion are not fully understood.
Purpose of the Study:
- To investigate the prevalence of microembolic signals (MES) in patients with symptomatic carotid stenosis or occlusion.
- To characterize infarct topography and report 90-day clinical outcomes in this patient cohort.
Main Methods:
- Prospective observational cohort study of patients hospitalized within 7 days of ischemic stroke or TIA due to ≥50% carotid stenosis or occlusion.
- Transcranial Doppler (TCD) used for emboli detection in the middle cerebral artery ipsilateral to the symptomatic carotid.
- Analysis of infarct patterns and recurrent cerebral ischemia rates at 90 days.
Main Results:
- MES were detected in 38% of 47 analyzed patients (19 carotid occlusion, 28 stenosis), with no significant difference between groups.
- Among patients with infarction, watershed patterns were observed in 38%, non-watershed in 41%, and combined in 21%.
- MES were present in 40% of patients with watershed infarcts; 19% experienced recurrent ischemia, with no difference based on MES presence.
Conclusions:
- Cerebral embolization is a significant factor in ischemic events for both carotid occlusion and stenosis, including watershed infarcts.
- Findings suggest a potential role for aggressive antithrombotic and antiplatelet therapies in symptomatic carotid occlusions, meriting further investigation.
