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Transcranial Doppler and Microemboli Detection: Relationships to Symptomatic Status and Histopathology Findings
Carol C Mitchell1, Stephanie M Wilbrand2, Bornali Kundu2
1Department of Medicine, Cardiovascular Medicine Division, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Insights
Microemboli detection via transcranial Doppler (TCD) did not differ between symptomatic and asymptomatic patients. However, microemboli presence correlated with plaque ulceration, suggesting similar instability in both groups for stroke prevention.
Area of Science:
- Neurology
- Vascular Surgery
- Pathology
Background:
- Carotid artery plaque instability is a key factor in ischemic stroke.
- Transcritical Doppler (TCD) can detect microemboli, potential indicators of plaque activity.
- Plaque histopathology provides insights into the nature of atherosclerotic lesions.
Purpose of the Study:
- To investigate the relationship between symptomatic status, TCD-detected microemboli, and carotid plaque histopathology.
- To determine if microemboli presence or plaque characteristics differ between symptomatic and asymptomatic patients undergoing carotid endarterectomy.
Main Methods:
- Sixty patients (37 symptomatic, 23 asymptomatic) undergoing carotid endarterectomy had TCD performed.
- Microemboli signals were recorded.
- Macroscopic and histopathological analyses of excised carotid plaques were conducted.
Main Results:
- No significant difference in microemboli signal frequency was found between symptomatic and asymptomatic groups (p=0.88).
- Macroscopic and histopathology scores showed no significant differences between the groups (p>0.05).
- Microemboli presence was significantly associated with plaque ulceration (p=0.034), with increased odds of 5.86 for each ulceration level increase.
Conclusions:
- Carotid plaques in both symptomatic and asymptomatic patients share similar instability features and embolic potential.
- Plaque ulceration is a key indicator of microemboli presence, irrespective of clinical presentation.
- Further research into novel methods for assessing plaque instability is crucial for optimizing stroke prevention strategies.
Abstract:
The purpose of this study was to determine the relationship between symptomatic status, transcranial Doppler (TCD) microemboli presence and plaque histopathology findings. TCD was performed on 60 patients (37 symptomatic, 23 asymptomatic) before undergoing clinically indicated carotid endarterectomy. The frequency of microemboli signals was not significantly different between symptomatic and asymptomatic subject groups (p = 0.88) and there were no differences observed in the macroscopic or histopathology scoring of these plaques (p-values all > 0.05). The presence of microemboli was associated with an ulceration score (regardless of symptomatic or asymptomatic status, p = 0.034), with a one-level increase in ulceration rating associated with an odds ratio of 5.86 (95% [CI] 1.55, 43.4). These findings suggest that both symptomatic and asymptomatic patients may have plaque with similar features of instability and ability to create emboli. Thus, identifying new ways to measure plaque instability may provide important information for optimizing treatment to prevent future stroke.
