title: Leukocyte count predicts microembolic Doppler signals during carotid stenting: a link between inflammation and embolization.
abstract: OBJECTIVE
  Protected stenting has emerged as a safe and effective alternative to endarterectomy for the treatment of carotid stenosis in patients at high operative risk. Distal microembolization occurs invariably during carotid stenting. Little is known about the relationship between systemic inflammation and embolization during carotid stenting.
  
  
  METHODS
  We examined 43 consecutive patients who underwent carotid stenting with simultaneous transcranial Doppler (TCD) monitoring of the ipsilateral middle cerebral artery. Embolization was quantified by measuring microembolic signals (MES) on TCD. Preprocedure leukocyte counts were related to MES.
  
  
  RESULTS
  In unadjusted analyses, preprocedure leukocyte count was positively correlated with total procedural MES (r2= 0.16; P=0.008). After considering age, gender, comorbidities, concomitant medical therapies, and the use of emboli prevention devices, increasing leukocyte count (beta=35 for each 1000/microL increment; P=0.018) remained a significant and independent predictor of embolization (model-adjusted r2=0.365; P=0.0005).
  
  
  CONCLUSIONS
  Increasing preprocedure leukocyte count independently predicted more frequent MES during carotid stenting. These data suggest that systemic inflammation may influence the degree of procedural embolization.
authors.affiliation: Michigan Heart PC, 5325 Elliott Dr, Ypsilanti, MI 48197, USA. haronow@michiganheart.com
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Aronow
authors.forename: Mehdi
authors.initials: M
authors.lastname: Shishehbor
authors.forename: Donalee A
authors.initials: DA
authors.lastname: Davis
authors.forename: Irene L
authors.initials: IL
authors.lastname: Katzan
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Bajzer
authors.forename: Alex
authors.initials: A
authors.lastname: Abou-Chebl
authors.forename: Krieger W
authors.initials: KW
authors.lastname: Derk
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Whitlow
authors.forename: Jay S
authors.initials: JS
authors.lastname: Yadav
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000473:pathology; D016893:Carotid Stenosis / Q000473:pathology / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D007958:Leukocyte Count; D007962:Leukocytes / Q000166:cytology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D012306:Risk; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler