Related Experiment Videos
[Detection of microemboli by transcranial Doppler sonography after carotid endarterectomy]
Y Akiyama1, H Yoshimoto, K Nagatsuka
1Department of Cerebrovascular Surgery, National Cardiovascular Center.
Insights
Transcranial Doppler sonography (TCD) can detect microemboli, a stroke risk factor. This study shows microemboli significantly decrease after carotid endarterectomy (CEA), suggesting CEA
Area of Science:
- Neurology
- Vascular Surgery
- Medical Imaging
Background:
- Microemboli from the extracranial internal carotid artery are a potential stroke risk factor.
- Transcranial Doppler sonography (TCD) is a non-invasive method for detecting these microemboli.
- Carotid endarterectomy (CEA) aims to remove the source of potential emboli.
Purpose of the Study:
- To determine if microemboli, detected by TCD, cease following CEA.
- To assess the efficacy of CEA in reducing microembolic signals.
Main Methods:
- Utilized TCD monitoring in 43 patients before and after CEA.
- Monitored the ipsilateral middle cerebral artery for high-intensity transient signals (microemboli) for one hour.
- Categorized post-CEA monitoring into acute (3-7 days), subacute (14-21 days), and chronic (>3 months) stages.
Main Results:
- Preoperatively, microemboli were detected in 23.3% of cases.
- Immediately after CEA and in the subacute/chronic stages, no microemboli were detected.
- In the acute stage post-CEA, microemboli were detected in 7.0% of cases.
- A significant reduction in TCD-detected microemboli was observed after CEA.
Conclusions:
- CEA significantly reduces the rate of TCD-detected microemboli.
- TCD monitoring can be a valuable tool to evaluate the effectiveness of CEA in preventing stroke by eliminating embolic sources.
Abstract:
Transcranial Doppler sonography (TCD), a non-invasive monitoring technique, has potential for detecting microemboli caused by the extracranial internal carotid artery. Many previous reports have shown that TCD-detected microemboli may be a risk factor for stroke. The main purpose of this study is to verify whether microemboli cease after carotid endarterectomy (CEA). TCD monitoring was performed in 43 cases before and after CEA. TCD monitoring was carried out for an hour at the ipsilateral middle cerebral artery of each case using a 2-MHz pulse-wave transcranial Doppler device, and high intensity transient signals were counted as microemboli. Microemboli were detected preoperatively in 10 cases (23.3%). Microemboli were not detected in any case immediately after CEA, in either the subacute stage (from 14 to 21 days after CEA) or in the chronic stage (more than 3 months after CEA). In the acute stage (from 3 to 7 days after CEA), microemboli were detected in three cases (7.0%). The rate of TCD-detected microembolic was always significantly reduced after CEA. TCD monitoring can be helpful in assessing the effect of CEA for prevention of stroke by removing the suspected source of microemboli.