Cerebral Microembolism and the Risk of Ischemia in Asymptomatic High-Grade Internal Carotid Artery Stenosis

Author:

Siebler Mario1,Nachtmann Andreas1,Sitzer Matthias1,Rose Georg1,Kleinschmidt Andreas1,Rademacher Jörg1,Steinmetz Helmuth1

Affiliation:

1. From the Department of Neurology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany.

Abstract

Background and Purpose Previous work has shown that cerebral microembolism detected with transcranial Doppler sonography distal to internal carotid artery stenosis occurs more frequently in recently symptomatic compared with asymptomatic patients. It has remained unclear whether cerebral microembolism also indicates a higher risk of future cerebral or retinal ischemia. Summary of Report Sixty-four asymptomatic patients with unilateral 70% to 90% internal carotid artery stenosis were investigated prospectively (mean follow-up, 72 weeks). Five patients developed ischemic symptoms attributable to the stenosis (transient ischemic attack, 2 patients; stroke, 3 patients). A microembolic rate of ≥2 per hour in the ipsilateral middle cerebral artery was associated with a substantially increased risk of developing ischemia of the corresponding carotid territory (odds ratio, 31; 95% confidence interval, 3 to 302; P =.005). Conclusions This prospective pilot study suggests that cerebral microembolism detected with transcranial Doppler sonography may define a high-risk subgroup among patients with asymptomatic high-grade internal carotid artery stenosis.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

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