SILENT EMBOLI AND THEIR RELATION TO CLINICAL SYMPTOMS IN EXTRACRANIALCAROTID-ARTERY DISEASE

A history of recent ischemic symptoms is known to define a high-risk s ubgroup among patients with high-grade extracranial internal carotid a rtery (ICA) disease. Our data show that at least such a positive histo ry can be predicted with high confidence using transcranial Doppler mo nitoring for (clinically silent) cerebral microembolism ipsilateral to severe ICA stenosis. Pathoanatomic work in progress suggests that lum inal ulcer and thrombosis are major sources of these microemboli. Thus , by studying an important pathomechanism, the detection of silent emb oli appears to provide independent, paraclinical evidence of 'unstable ICA disease'.