title: Postinterventional microembolism signals detected by transcranial Doppler ultrasound after carotid artery stenting.
abstract: BACKGROUND
  The occurrence of early post-procedural complications after carotid artery stenting (CAS) can be attributed to embolization of thrombus or plaque particles released from the stented segment. Vascular emboli can be non-invasively detected by transcranial Doppler ultrasound as microembolic signals (MES). We performed this study to discover factors predicting MES detected by transcranial Doppler (TCD)-monitoring within the early post-interventional phase.
  
  
  METHODS
  In 134 consecutive patients undergoing CAS, transcranial Doppler monitoring of the ipsilateral middle cerebral artery was performed for MES detection during the first post-interventional hour. To identify clinical, morphologic, and procedure-related parameters likely to predict the occurrence of post-interventional MES a logistic regression analysis was performed.
  
  
  RESULTS
  In 134 patients (111 male, mean age 69.7 years) relevant MES were detected in 51 patients (38 %) with a median of 4 MES/h and a maximum of 62 MES/h. Three factors were observed to be associated with increased post-interventional MES-counts. These included symptomatic lesion (p < 0.05), elevated total cholesterol (p < 0.05), and aspirin monotherapy (p < 0.0005). In a binary logistic regression model, dual antiplatelet therapy (OR 5.6, p < 0.0005) and asymptomatic lesions (OR 2.6, p < 0.05) were revealed as independent predictors for the absence of post-interventional MES.
  
  
  CONCLUSIONS
  Post-interventional MES were most likely in symptomatic lesions and patients with elevated cholesterol. The absence of an effective dual antiplatelet therapy and symptomatic lesions were revealed as independent predictors for post-interventional MES. An effective pre-interventional dual antiplatelet and lipid lowering therapy might improve the safety of CAS.
authors.affiliation: Center of Vascular Medicine, Angiology and Vascular Surgery, Parkkrankenhaus Leipzig, Germany, and Cardioangiological Center Bethanien (CCB), Frankfurt, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Piorkowski
authors.affiliation: Division of Cardiology/Angiology, Department of Medicine III, Goethe University Frankfurt, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Kläffling
authors.affiliation: Faculty of Health, Witten/Herdecke University, Germany.
authors.forename: Spiridon
authors.initials: S
authors.lastname: Botsios
authors.affiliation: Department of Vascular Medicine, Angiology, Phlebology, University Heart Center Freiburg, Bad Krozingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Zerweck
authors.affiliation: Center of Vascular Medicine, Angiology and Vascular Surgery, Parkkrankenhaus Leipzig, Germany, and Department for Interventional Angiology, University Hospital Leipzig, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Scheinert
authors.affiliation: Center of Vascular Medicine, Angiology and Vascular Surgery, Parkkrankenhaus Leipzig, Germany, and Department for Interventional Angiology, University Hospital Leipzig, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Banning-Eichenseher
authors.affiliation: Center of Vascular Medicine, Angiology and Vascular Surgery, Parkkrankenhaus Leipzig, Germany, and Department for Interventional Angiology, University Hospital Leipzig, Germany.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Bausback
authors.affiliation: Center of Vascular Medicine, Angiology and Vascular Surgery, Parkkrankenhaus Leipzig, Germany, and Department for Interventional Angiology, University Hospital Leipzig, Germany.
authors.forename: Dierk
authors.initials: D
authors.lastname: Scheinert
authors.affiliation: Center of Vascular Medicine, Angiology and Vascular Surgery, Parkkrankenhaus Leipzig, Germany, and Department for Interventional Angiology, University Hospital Leipzig, Germany.
authors.forename: Andrej
authors.initials: A
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*
keywords: Transcranial doppler; antiplatelet therapy; carotid artery; risk factors; stent