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Embolus detection in different degrees of carotid disease
B M Eicke1, J von Lorentz, W Paulus
1Dept. of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany.
Insights
Transcarotid Doppler (TCD) monitoring for embolic signals can identify patients at high risk for stroke. Detecting microemboli correlates with stroke history, aiding in risk stratification for carotid atherosclerotic disease.
Area of Science:
- Neurology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Carotid atherosclerotic disease is a primary cause of artery-to-artery embolism.
- Stroke risk is significantly influenced by the severity of carotid artery stenosis.
Purpose of the Study:
- To correlate the degree of carotid stenosis with the presence of embolic signals detected by TCD.
- To evaluate the association between embolic signals and clinical outcomes in patients with carotid disease.
Main Methods:
- Bilateral simultaneous Transcarotid Doppler (TCD) studies were conducted on four patient groups with unilateral atherosclerotic disease.
- Groups included: non-stenotic internal carotid artery (ICA) plaques (n=21), 50-75% ICA stenosis (n=20), 75-95% ICA stenosis (n=22), and ICA occlusion (n=13).
- Minimum insonation time was 45 minutes per patient.
Main Results:
- Embolic signals were absent in controls and non-stenotic lesions.
- Embolic signals were detected in 10% of patients with 50-75% stenosis, 22% with high-grade stenosis, and 39% with ICA occlusion.
- Microemboli showed high specificity (92%) but low sensitivity (29%) for past clinical events.
- Embolic signal occurrence significantly correlated with a history of stroke, TIA, or RIND (p < 0.005).
Conclusions:
- Microemboli detection using TCD is a valuable tool for identifying patients at high risk for impending stroke.
- The presence of embolic signals correlates with the degree of carotid stenosis and past cerebrovascular events.
Abstract:
Carotid atherosclerotic disease is a major source for artery to artery embolism. Stroke incidence highly depends on the degree of carotid stenosis. TCD monitoring for embolic signals may help to identify patients at high risk for an impeding stroke. This study was performed to correlate the degree of carotid stenosis with the occurrence of embolic signals and the clinical outcome. We performed a bilateral simultaneous TCD study on 4 patient groups with unilateral atherosclerotic disease: We studied patients with non-stenotic ICA plaques (n = 21), 50-75% ICA stenosis (n = 20), 75-95% stenosis (n = 22), and occlusion (n = 13). Minimum insonation time was 45 minutes. Embolic signals were not detected in the control group and patients with a non-stenotic ICA lesion, but in 10% of the patients with 50-75% stenosis, 22% of the patients with a high grade stenosis and 39% of the patients with an ICA occlusion. There is a high specificity (92%) and rather low sensitivity (29%) of these microemboli for past clinical events. The occurrence of embolic signals correlated (p < 0.005) with a history of stroke, TIA or RIND. Microemboli detection may be a valuable tool to identify high risk patients.