Microemboli detected by transcranial Doppler monitoring in patients duringcarotid angioplasty versus carotid endarterectomy

Microemboli, as detected by transcranial Doppler monitoring, have been show n to be a potential cause of strokes after carotid endarterectomy, We retro spectively reviewed 105 patients who underwent transcranial Doppler monitor ing during 112 procedures for the treatment of 115 carotid bifurcation sten oses: 40 by percutaneous angioplasty with stenting and 75 by carotid endart erectomy, In PTAS procedures (n = 40), there was a mean of 74.0 emboli per stenosis (range 0-398, P = 0.0001) with 4 neurologic events per patient (P = 0.08). In CEA procedures (n = 76), there was a mean of 8.8. emboli per st enosis (range 0-102, P = 0.0001) with 1 neurologic event per patient (P = 0 .08). The post-procedural neurological events in the percutaneous angioplas ty with stenting population included two strokes (5.6%) and two transient i schemia attacks (5.6%). Microemboli for each of these cases totalled 133, 1 7, 29 and 47 (with one shower), respectively, One postoperative carotid end arterectomy patient was noted to have a stroke (1.4%), with 48 microemboli noted during that procedure. The mean emboli rate for percutaneous angiopla sty with stenting patients with neurological events was 59.0: without compl ications it was 85.1. The mean emboli rate for carotid endarterectomy patie nts without complications was 8.3. Three percutaneous angioplasty with sten ting patients had no emboli (7.5%), whereas 29 carotid endarterectomy patie nts had no emboli (38.7%), Conclusion: The percutaneous angioplasty with st enting procedure is associated with more than eight times the rate of micro emboli seen during carotid endarterectomy when evaluated with transcranial Doppler monitoring. Larger patient groups are needed to determine if this g reater embolization rate has an associated risk of higher morbidity or mort ality, (C) 1998 The International Society for Cardiovascular Surgery, Publi shed by Elsevier Science Ltd. All rights reserved.