With more intensive medical therapy, the risk of stroke or death in patients with asymptomatic carotid stenosis is now so low that most patients will not benefit from endarterectomy or stenting 1 . It is therefore important to have methods to identify the small proportion who could benefit from intervention 1,2 , or who may require special consideration in choice of medical therapy. We have previously reported that carotid plaque area 3 , microemboli on transcranial Doppler 4,5 (TCD), and carotid plaque ulceration on 3-dimensional ultrasound 5 predict the risk of cardiovascular events, particularly of stroke. The predictive value of TCD microembolus detection in patients with ABSTRACT: Background: The risk of stroke in patients with asymptomatic carotid stenosis (ACS) is now so low that it is important to have methods to identify those patients most likely to benefit from intervention, or who may require special consideration in choice of medical therapy. We studied the prediction of stroke, death or transient ischemic attacks (stroke/death/TIA) in patients with ACS by intracranial arterial stenosis, and microemboli on transcranial Doppler (TCD), and the effect of diabetes mellitus on microemboli, intracranial stenosis and risk of events. Methods: Patients with ACS > 60% by Doppler ultrasound were recruited from the Stroke Prevention Clinic of University Hospital, London, Canada. All 339 participants underwent TCD for detection of intracranial stenosis and detection of microemboli, and carotid ultrasound to measure extracranial stenosis and total carotid plaque area. Participants were followed for three years, to determine the risk of stroke/death/TIA. Results: Stroke/death/TIA occurred in 38% of patients with microemboli versus 10% without (p=0.0001), and in 18% of patients with intracranial stenosis, versus 10% without (p=0.042). Diabetics were significantly more likely to have intracranial stenosis (45% vs. 29%, p =0.014), microemboli (38% vs. 10%, p <0.0001), and had significantly higher risk of stroke/death/TIA over three years (21% vs. 11% without; p=0.024). Survival free of stroke, TIA or death was significantly better without microemboli or intracranial stenosis (p<0.0001). Conclusions: Diabetes, microemboli and intracranial stenosis predicted higher risk of stroke, death or TIA than did extracranial stenosis or total plaque area; diabetics may need more intensive therapy.RÉSUMÉ: Diabète, sténose intracrânienne et microembolies dans la sténose carotidienne asymptomatique. Contexte : Le risque d'accident vasculaire cérébral (AvC) chez les patients porteurs d'une sténose carotidienne asymptomatique (SCA) est maintenant si faible qu'il est important d'établir des critères pour identifier les patients qui sont les plus susceptibles de bénéficier d'une intervention ou chez qui on doit porter une attention particulière au choix du traitement médical. nous avons examiné si la présence d'une sténose artérielle intracrânienne et de microembolies au Doppler transcrânien (DTC) étaient des facteurs de prédiction de ...

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