title: Predictability of cerebral embolization from aortic arch manipulations during thoracic endovascular repair.
abstract: There is no sensitive tool to monitor embolic events and predict patients at a risk for strokes during thoracic endovascular aortic repair. We examined the relationship between the number of high intensity transient signals (HITS) by transcranial doppler ultrasound and the extent of  atherosclerotic plaques in aortic arch. Thirteen patients were treated as a part of a single center United States Food and Drug Administration-approved investigational device exemption for various thoracic aortic pathologies. Bilateral transcranial doppler ultrasound transducers recorded the  number of HITS. CT angiography and intravascular ultrasound were used to measure the thickness of mural thrombi and determine their arch location. All 13 patients had detectable HITS, and one patient sustained a stroke. Eleven patients had quantifiable mural thrombi. The highest HITS were  observed in patients with thrombi in zones 2 to 3. All three patients with bovine arch had more HITS in the right middle cerebral artery whereas the patients with normal arch anatomy had more HITS in the left middle cerebral artery. The presence of mural thrombi in zones 2 and 3, irrespective  of their thickness, was associated with increased HITS during thoracic endovascular aortic repair. This is the first study to characterize the significance of mural thrombi in aortic arch and their relationship to embolic events during aortic arch manipulations.
authors: Division of Vascular and Endovascular Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA. Karen_minchung@yahoo.com
authors: Karen
authors: K
authors: Kim
authors: Tyler
authors: T
authors: Reynolds
authors: Carlos
authors: C
authors: Donayre
authors: George
authors: G
authors: Kopchok
authors: Rodney
authors: R
authors: White
authors: Christian
authors: C
authors: De Virgilio
authors: Joe
authors: J
authors: Chauvapun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017546:Angioscopy / Q000009:adverse effects* / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D018084:Ultrasonography, Interventional; D014481:United States / Q000453:epidemiology