Transcranial Doppler Detection of Microemboli During Percutaneous Transluminal Coronary Angioplasty

Abstract

Background and Purpose-The use of percutaneous transluminal coronary angioplasty (PTCA) to treat coronary artery disease is now commonplace. The occurrence of microemboli during invasive procedures such as cardiac angiography and bypass surgery is well documented, although neurological complications are relatively uncommon. To date, no investigation has been undertaken of the frequency or nature of microemboli occurring during PTCA or of the correlation with aortic atheroma. Methods-Twenty patients having elective PTCA underwent examination by transcranial Doppler ultrasonography (TCD) to detect left middle cerebral artery microemboli occurring during the procedure. Blinded off-line analysis correlated microembolic signal counts on TCD with the components of each stage of the PTCA. Patients later underwent transesophageal (TEE) echocardiography, with measurements made of the thickness of the intima and atheroma in the ascending and descending thoracic aortic arch by cardiologists blinded to the TCD results. Results-A total of 973 microembolic signals were detected (meanϮSD, 48.7Ϯ36.7 per patient); 196 (20%) occurred on movement of the PTCA catheter and wire around the aortic arch, 84 (9%) with other PTCA catheter-associated movements, and 679 (70%) in association with injection of solutions (eg, saline and contrast). Mean signal counts during contrast injection were significantly greater than during the other 3 phases (PϽ0.001). No neurological events occurred in the study. Although not statistically significant, there was a trend toward greater microembolic signal counts with the number of times the catheter was passed around the aortic arch and the amount of arch atheroma detected by transesophageal echocardiography. Conclusions-Microemboli detected on TCD are a common occurrence during PTCA but are largely asymptomatic. The majority of microembolic signals are most probably gaseous in origin and do not appear to be related to the extent of aortic atheroma or to clinical events.

Carotid Atherosclerosis as a Risk Factor for Complex Aortic Lesions in Patients With Ischemic Cerebrovascular Disease

“…Moreover, aortogenic cerebral embolism, whether symptomatic or asymptomatic, can occur during coronary or cerebral arteriography, and other aortic manipulations. [13][14][15] Based on our findings, carotid evaluation prior to the procedures may help in the assessment of procedure-related risk for cerebral embolism, when TEE is not available.…”

Heparin and Air Filters Reduce Embolic Events Caused by Intra-Arterial Cerebral Angiography

“…25 A large number of microembolic signals in the cerebral vessels has been described not only during cerebral angiography 9 but also during cardiological intra-arterial procedures. 25,26 This finding has been attributed primarily to tiny air bubbles introduced by contrast medium or flushing solution. 9,26,27 In the present study, we identified 2 patterns of MES: single MESs, which occurred during all phases of angiography, and MES showers, which were related exclusively to injections of contrast medium.…”

Evaluation of the Medtronic Exponent Self-Expanding Carotid Stent System With the Medtronic Guardwire Temporary Occlusion and Aspiration System in the Treatment of Carotid Stenosis

“…6 -12 Without embolic protection, the benefit of CAS over CEA has been questioned. [13][14][15] The development of mechanical cerebral protection devices that prevent friable carotid plaque from embolizing to the brain is likely the major technical advancement that has made endovascular management relatively safer than CEA in regard to cerebral ischemic complications. 16 The MAVErIC (Medtronic AVE Self-expanding CaRotid Stent System with distal protection In the treatment of Carotid stenosis) I and II trials were designed to assess the feasibility, safety, and efficacy of using a distal protection device in combination with a self-expanding carotid stent in patients at high risk for CEA (Supplemental Table I).…”