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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Malignant emboli on transcranial doppler during carotid stenting predict postprocedure diffusion-weighted imaging lesions
Stroke, Volume 44, No. 5, Year 2013
Notification
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Description
BACKGROUND AND PURPOSE-: Carotid angioplasty and stenting (CAS) has a higher incidence of periprocedural stroke compared with endarterectomy. Identifying CAS steps with the highest likelihood of embolization may have important implications. We evaluated CAS safety by correlating the findings of procedural transcranial Doppler with postprocedure diffusion-weighted imaging (DWI) lesions. METHODS-: In this prospective study, transcranial Doppler monitoring was performed during CAS procedures, which were divided into 11 steps. Embolic signals on transcranial Doppler were counted and classified based on the relative energy index of microembolic signals into microemboli ≤1 or malignant macroemboli >1. Poststenting MRI was performed in all cases. A negative binomial regression model was used to evaluate the predictive value of transcranial Doppler emboli for new DWI lesions. RESULTS-: Thirty subjects were enrolled. Seven of 30 subjects (23.3%) were asymptomatic. The median embolic signal count was 212.5 (108 microemboli and 80 malignant macroemboli). Stent deployment phase showed the highest median embolic signals count at 58, followed by protection device deployment at 30 (P=0.0006). Twenty-four of 30 (80%) had new DWI lesions on post-CAS MRI. The median DWI count was 4 (interquartile range 7). Two of 30 (6.7%) had new or worsening clinical deficits post-CAS. For every malignant embolus, the expected count of DWI lesions increases by 1% (95% confidence interval, 0%-2%; P=0.032). CONCLUSIONS-: We observed a high incidence of embolic signals during CAS procedure, especially, when devices were deployed. Most subjects developed new DWI lesions, but only 6.7% had deficits. Malignant macroemboli predicted new DWI lesions. © 2013 American Heart Association, Inc.
Authors & Co-Authors
Almekhlafi, Mohammed A.
Canada, Calgary
Hotchkiss Brain Institute
Saudi Arabia, Jeddah
King Abdulaziz University
Demchuk, Andrew M.
Canada, Calgary
Hotchkiss Brain Institute
Mishra, Sachin M.
Canada, Calgary
Hotchkiss Brain Institute
Bal, Simerpreet
Canada, Winnipeg
University of Manitoba
Menon, Bijoy K.
Canada, Calgary
Hotchkiss Brain Institute
Wiebe, Samuel
Canada, Calgary
Hotchkiss Brain Institute
Clement, Fiona M.
Canada, Calgary
Hotchkiss Brain Institute
Wong, John H.
Canada, Calgary
Hotchkiss Brain Institute
Hill, Michael D.
Canada, Calgary
Hotchkiss Brain Institute
Goyal, Mayank K.
Canada, Calgary
Hotchkiss Brain Institute
Statistics
Citations: 32
Authors: 10
Affiliations: 3
Identifiers
Doi:
10.1161/STROKEAHA.111.000659
ISSN:
00392499
e-ISSN:
15244628
Research Areas
Cancer
Noncommunicable Diseases
Study Design
Cohort Study