Microembolic Signals Detected by Transcranial Doppler Sonography During Carotid Endarterectomy and Correlation With Serial Diffusion-Weighted Imaging

Wolf, Oliver T.; Heider, P.; Heinz, Michael; Poppert, Holger; Sander, Dirk; Greil, O.; Weiß, Wolfgang; Hanke, Marc; Eckstein, H.‐H.

doi:10.1161/01.str.0000143184.69343.ec

Cited by 95 publications

(70 citation statements)

References 10 publications

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“…Transcranial Doppler sonography has shown that the highest number of microembolic signals is detected during the declamping period. 17) We consider that shunting itself does not increase the risk of ischemic lesion, even clinically silent lesions detected only by diffusion-weighted MR imaging, if the shunt device is carefully used with meticulous preparation before insertion, and careful rinsing with heparinized saline through the third lumen as detailed in our endarterectomy method.…”

Section: Discussionmentioning

confidence: 99%

“…3,10,12) Therefore, the most common strategy to prevent ischemia during CEA is selective shunt usage based on the findings of electroencephalography (EEG), stump pressure, or transcranial Doppler sonography, to reduce the risk of embolic complication resulting from shunt device insertion or removal, 2,11,16) as shunting carries the risk of embolus release. 6,12,17) However, the intraoperative decisionmaking for selective shunt usage following monitoring changes during cross-clamping requires vast experience. In fact, most CEA series with good results performed with EEG monitoring and selective shunting occurred at large centers.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Inoue

Tsutsumi

Maeda³

et al. 2006

Neurol. Med. Chir.(Tokyo)

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Temporary intraluminal shunt was used during 72 consecutive carotid endarterectomies (CEAs) in 61 patients (bilateral CEA in 11 patients) during October 2001 and September 2005. The medical records of these patients were retrospectively reviewed. All procedures were performed with routine shunt insertion without monitoring such as electroencephalography. Pre-and postoperative diffusion-weighted magnetic resonance (MR) imaging was used to detect ischemic complications. Postoperative angiography was performed in 70 cases to detect abnormalities such as major stenosis or dissection of the distal end. Symptomatic ischemic complication occurred in one patient at 1 month. Postoperative diffusion-weighted MR imaging detected new hyperintense lesions in three patients including the symptomatic patient. Postoperative angiography confirmed that the distal end was satisfactory in all cases. The incidence of ischemic lesions of embolic origin after CEA with routine shunt usage is acceptably low if the procedure of shunt device insertion and removal is meticulously conducted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Inoue

Tsutsumi

Maeda³

et al. 2006

Neurol. Med. Chir.(Tokyo)

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“…Nineteen studies, with a total of 5570 individual patients, reported stroke as an outcome along with data for TCD recording of microembolic signals (7)(8)(9)(10)13,16,(18)(19)(20)23,(27)(28)(29)(30)(31)(32)(33)(34). The sensitivity and specificity were 73.14 (95% CI 48.16 to 88.86) and 70.27 (95% CI 58.61 to 79.78)* respectively.…”

Section: Strokementioning

confidence: 99%

“…Eight studies, with a total of 1414 individual patients, reported stroke or TIA as an outcome along with data for TCD recording of microembolic signals with high MES counts defined as positive (13,(17)(18)(19)21,32,33,35). The sensitivity and specificity were 52.…”

Section: Stroke or Tia High Mes Countmentioning

confidence: 99%

Transcranial Doppler Ultrasound Detection of Microemboli as a Predictor of Cerebral Events in Patients with Symptomatic and Asymptomatic Carotid Disease: A Systematic Review and Meta-Analysis

Best¹,

Webb

Gurusamy³

et al. 2016

European Journal of Vascular and Endovascular Surgery

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“…1,[20][21][22] Along the same lines, other studies have demonstrated that manipulation of the carotid artery during revascularization can cause atheroembolization with consequent silent cerebral microinfarcts. 1,[23][24][25] Transcranial Doppler (TCD) can differentiate gaseous from particulate microembolic material during revascularization procedures. 26,27 Gaunt et al…”

Section: -17mentioning

confidence: 99%

The impact of carotid revascularization on cognitive function

et al. 2014

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The concept that carotid disease may compromise cognitive function was initially proposed by Fisher in 1951, based on an autopsy case. However, some topics involving cognitive function remain controversial, such as its correlation with carotid obstructive disease. So, the authors of this review evaluate the impact of carotid revascularization on cognitive function and the repercussions of the revascularization technique (carotid stenting vs. endarterectomy) chosen. It was clear from the literature reviewed that carotid stenosis is related to a decline in cognitive function over time. However, controversy still remains over the impact of carotid revascularization on cognitive function. With elation to the technique employed (carotid stenting vs. endarterectomy), the majority of studies found no difference between the two techniques in terms of overall cognitive outcome.Keywords: carotid stenosis; therapy; carotid endarterectomy; cognition. ResumoA noção de que a doença carotídea pode comprometer a função cognitiva foi proposta inicialmente por Fisher, em 1951, baseado em um caso de necropsia. Porém, alguns tópicos envolvendo a função cognitiva permanecem controversos, tais como sua correlação com a doença obstrutiva da carótida. Nesse sentido, os autores desta revisão buscam avaliar o impacto da revascularização carotídea e a repercussão da técnica de revascularização empregada (endarterectomia versus angioplastia carotídea) sobre a função cognitiva. A partir da literatura levantada, ficou claro que as estenoses carotídeas estão relacionadas com o declínio cognitivo ao longo do tempo, mas ainda há controvérsia no que se refere ao impacto da revascularização carotídea sobre a função cognitiva. Quanto à técnica empregada (angioplastia versus endarterectomia carotídeas), a maioria dos estudos não demonstrou distinção entre as duas técnicas quanto ao desfecho cognitivo geral. Palavras R E V I E W A R T I C L EGermano da Paz Oliveira, Ana Terezinha Guillaumon et al. stenting; cognitive changes; cognitive function. Results were restricted to articles published in English.Articles of interest identified by the initial search strategy were first independently assessed by two of the authors. In order to avoid the risk of excluding any studies that could be important to the review, a consensus meeting was held and then both reviewers chose all the titles they had identified as potentially relevant to the object of study, irrespective of whether or not an abstract was available. Once relevant titles had been selected, the full texts of the articles were acquired and each article was assessed against a protocol covering the following topics: study type, sample, type of intervention used, results observed. All longitudinal, prospective and retrospective articles, meta-analyses and review articles that met the criteria were included.Articles not yet published, comments and editorials, case reports and crosssectional studies were all excluded. Articles with very similar content were also excluded, giving priority to th...

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Microembolic Signals Detected by Transcranial Doppler Sonography During Carotid Endarterectomy and Correlation With Serial Diffusion-Weighted Imaging

Cited by 95 publications

References 10 publications

Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Transcranial Doppler Ultrasound Detection of Microemboli as a Predictor of Cerebral Events in Patients with Symptomatic and Asymptomatic Carotid Disease: A Systematic Review and Meta-Analysis

The impact of carotid revascularization on cognitive function

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