Prevalence of Micro-Emboli in Symptomatic High Grade Carotid Artery Disease: A Transcranial Doppler Study

Žuromskis, Tadas; Wetterholm, Robert; Lindqvist, Johan Fredén; Svedlund, Sara; Sixt, C.; Jatužis, Dalius; Obelienienė, Diana; Caidahl, Kenneth; Volkmann, Reinhard

doi:10.1016/j.ejvs.2008.01.001

Cited by 23 publications

(10 citation statements)

References 34 publications

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“…In this study, compression of the CCA did not elicit cerebral symptoms in any case. It had been reported that in 98% of symptomatic ICA disease, putting pressure on the CCA does not provoke additional microembolic signals despite a 30% probability of spontaneous microembolizations when investigated preoperatively by power M-mode TCD (Zuromskis et al , 2008). …”

Section: Discussionmentioning

confidence: 99%

Functional assessment of high‐grade ICA stenosis with duplex ultrasound and transcranial Doppler

Zachrisson

Fouladiun²,

Blomstrand³

et al. 2012

Clin Physio Funct Imaging

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Background:Duplex ultrasound (DUS) has shown a >90% accuracy compared to angiography, concerning the degree of internal carotid artery (ICA) stenosis. However, uncertainty may occur in a severe stenosis, in which peak systolic velocity (PSV) may decrease owing to high flow resistance or high backward pressure. We investigated intracranial collateral flows using transcranial Doppler (TCD) to further evaluate the hemodynamic significance of high-grade ICA stenosis.Methods:In this retrospective study, 320 consecutive symptomatic patients were examined. The degree of ICA stenosis and collateral capacity in the circle of Willis was investigated by DUS and TCD. In addition, magnetic resonance angiography (MRA) was added in a subgroup of 204 patients. The criterion for hemodynamic significant ICA stenosis was established collateral flow.Results:In 91% of all symptomatic vessels (291 vessels), an ICA stenosis of ≥70% was found. Established collateral flow always indicated precerebral carotid artery disease of ≥70%. Furthermore, in 11% of the whole study material, collateral reserve capacity was found despite high-grade (≥70%) ICA stenosis. PSV in ICA <2·5 m s−1 was combined with established collateral flow and MRA stenosis of ≥70% in 9% (19 arterial systems). In 4%, doubt existed concerning the degree of stenosis after DUS.Conclusion:Transcranial Doppler helps to determine whether an ICA stenosis is of hemodynamic significance and to assess collateral patterns. Established collateral blood flow will help to identify patients with ≥70% (ECST) carotid artery disease. TCD might be of value when flow velocity criteria combined with plaque assessment by DUS are inclusive. Other diagnostic methods may also be considered.

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Section: Discussionmentioning

confidence: 99%

Functional assessment of high‐grade ICA stenosis with duplex ultrasound and transcranial Doppler

Zachrisson

Fouladiun²,

Blomstrand³

et al. 2012

Clin Physio Funct Imaging

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“…The correlation between stenosis degree and MESs has been previously studied which led to somewhat controversial results. Some studies found that MESs were significantly more frequent in patients with higher degree of carotid stenosis [ 6 , 9 ], while other studies did not find the association between the presence of MES and an increasing in carotid stenosis degree [ 10 – 13 ], which suggested there might be factors other than stenosis degree playing a major role in determining high-risk condition of ischemic events. Though there is intrinsical link between artery stenosis and atherosclerotic plaque.…”

Section: Is the Mechanism Of Cerebral Infarction Vascular Stenosismentioning

confidence: 99%

The Vulnerability of Vessels Involved in the Role of Embolism and Hypoperfusion in the Mechanisms of Ischemic Cerebrovascular Diseases

Tan

2016

BioMed Research International

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Accurate definition and better understanding of the mechanisms of stroke are crucial as this will guide the effective care and therapy. In this paper, we review the previous basic and clinical researches on the causes or mechanisms of ischemic cerebrovascular diseases (ICVD) and interpret the correlation between embolism and hypoperfusion based on vascular stenosis and arterial intimal lesions. It was suggested that if there is no embolus (dynamic or in situ emboli), there might be no cerebral infarction. Three kinds of different clinical outcomes of TIA were theoretically interpreted based on its mechanisms. We suppose that there is a correlation between embolism and hypoperfusion, and which mechanisms (hypoperfusion or hypoperfusion induced microemboli) playing the dominant role in each type of ICVD depends on the unique background of arterial intimal lesions (the vulnerability of vessels). That is to say, the vulnerability of vessels is involved in the role of embolism and hypoperfusion in the mechanisms of ischemic cerebrovascular diseases. This inference might enrich and provide better understandings for the underlying etiologies of ischemic cerebrovascular events.

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“…Despite optimum standard antiplatelet therapy, cerebral microembolisation occurs in 30% of patients with symptomatic carotid artery disease [27]. Patients with symptomatic high-grade ICA stenosis and who were on antiplatelet treatment underwent bilateral MES monitoring for 30 minutes.…”

Section: Clinical Condition In Which Mes May Be Detectedmentioning

confidence: 99%

“…The study has shown that the presence of MES is independent of intrastenotic blood flow disturbances and gray-scale ultrasound plaque characteristics. The authors concluded that the presence of MES is an indicator of an unstable plaque [27]. …”

Section: Clinical Condition In Which Mes May Be Detectedmentioning

confidence: 99%

Microembolus Detection by Transcranial Doppler Sonography: Review of the Literature

Cvetković

2012

Stroke Research and Treatment

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Transcranial Doppler can detect microembolic signals which are characterized by unidirectional high intensity increase, short duration, random occurrence, and a “whistling” sound. Microembolic signals have been detected in a number of clinical settings: carotid artery stenosis, aortic arch plaques, atrial fibrillation, myocardial infarction, prosthetic heart valves, patent foramen ovale, valvular stenosis, during invasive procedures (angiography, percutaneous transluminal angioplasty), surgery (carotid, cardiopulmonary bypass, orthopedic), and in certain systemic diseases. Microembolic signals are frequent in large artery disease, less commonly detected in cardioembolic stroke, and infrequent in lacunar stroke. This article provides an overview about the current state of technical and clinical aspects of microembolus detection.

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Prevalence of Micro-Emboli in Symptomatic High Grade Carotid Artery Disease: A Transcranial Doppler Study

Cited by 23 publications

References 34 publications

Functional assessment of high‐grade ICA stenosis with duplex ultrasound and transcranial Doppler

Functional assessment of high‐grade ICA stenosis with duplex ultrasound and transcranial Doppler

The Vulnerability of Vessels Involved in the Role of Embolism and Hypoperfusion in the Mechanisms of Ischemic Cerebrovascular Diseases

Microembolus Detection by Transcranial Doppler Sonography: Review of the Literature

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