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Transcranial Doppler in the evaluation of internal carotid artery dissection
J Srinivasan1, D W Newell, M Sturzenegger
1Department of Neurological Surgery, University of Washington School of Medicine, Seattle, 98104, USA.
Insights
Transcranial Doppler (TCD) monitoring detected intracranial microemboli in 59% of internal carotid artery (ICA) dissection patients. Microemboli presence significantly correlated with stroke risk, suggesting TCD
Area of Science:
- Neurology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Internal carotid artery (ICA) dissection presents diverse symptoms, including stroke.
- Identifying patients at risk for cerebral ischemia remains challenging.
- Embolic phenomena are a primary cause of ischemic events in ICA dissection.
Background And Purpose:
A subject with dissection of the internal carotid artery (ICA) may present with a variety of symptoms, from headache to stroke. Thus far, it has not been possible to identify the subset of patients at risk for cerebral ischemia. Because the majority of these ischemic events are secondary to embolic phenomena, we used transcranial Doppler (TCD) evaluation with emboli monitoring to study 17 consecutive patients with ICA dissection treated at Harborview Medical Center, Seattle, Wash, during a 2-year period from 1992 until 1994.
Methods:
Ten patients with ICA dissection secondary to trauma and seven with spontaneous ICA dissection were diagnosed by carotid angiography and studied by TCD from the time of diagnosis through initiation of therapy. Emboli monitoring was performed in the middle cerebral artery (MCA) ipsilateral to the dissection at the initial evaluation and intermittently thereafter to ensure that the emboli stopped with treatment.
Results:
Emboli were detected in the MCA distal to the dissection in 10 of 17 patients (59%). Patients with microemboli detected by TCD presented with a stroke (70%) much more frequently than those without emboli (14%) (P=.0498). The presence of a pseudoaneurysm did not increase the risk of either microemboli or stroke.
Conclusions:
We have demonstrated a high incidence of intracranial microemboli in the MCA distal to carotid dissections and a significant correlation between the presence of emboli and stroke. TCD can therefore be used as an adjunctive tool to manage patients with suspected carotid dissection and may prove useful in evaluating the efficacy of treatment in reducing microemboli and subsequent stroke.