Characteristics of cerebral microembolism during carotid stenting and angioplasty alone.
BACKGROUND
Cerebral microembolism has often been documented by transcranial Doppler imaging during carotid angioplasty and stenting. However, few data are available about its characteristics during the 2 different kinds of procedure.


OBJECTIVE
To compare the incidence of microemboli occurring during angioplasty alone with that during stenting in the different phases of the procedures and to relate it to periprocedural cerebrovascular complications.


METHODS
Thirty-eight patients underwent 41 procedures (15 angioplasty alone and 26 stenting) for symptomatic carotid stenoses of 70% or more. Transcranial Doppler monitoring was performed to detect microemboli in the middle cerebral artery during 3 phases of the procedure: (1) guidewire crossing, (2) first dilatation in case of angioplasty alone or stent release with predilatation if performed, and (3) further dilatation.


RESULTS
Microemboli occurred in all cases in phase 1 of the procedure but less frequently in the arteries treated with stenting when compared with those treated with angioplasty alone in phase 2 and particularly (P<.02) in phase 3. The mean number of microemboli was highest in phase 2, predominant (P<.05) during angioplasty alone, and particularly reduced (P<.02) in phase 3 during the stenting procedures. During 2 (5%) of the 41 procedures, cerebrovascular complications occurred in phase 1, with the number of microemboli being higher than mean values.


CONCLUSIONS
Cerebral microembolism is a very common event, especially during guidewire crossing and angioplasty alone compared with stenting. Further studies concerning the prognostic significance of this are advisable.
Orlandi
G
G
Department of Neuroscience, Clinic of Neurology, University of Pisa, Via Roma 67, 56100 Pisa, Italy. g.orlandi@neuro.med.unipi.it
Fanucchi
S
S
Fioretti
C
C
Acerbi
G
G
Puglioli
M
M
Padolecchia
R
R
Sartucci
F
F
Murri
L
L
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D017585:Ultrasonography, Doppler, Transcranial