F. Crawley et al., COMPARISON OF HEMODYNAMIC CEREBRAL-ISCHEMIA AND MICROEMBOLIC SIGNALS DETECTED DURING CAROTID ENDARTERECTOMY AND CAROTID ANGIOPLASTY, Stroke, 28(12), 1997, pp. 2460-2464
Background and Purpose There has been concern about carotid percutaneo
us transluminal angioplasty (PTA) carrying a greater risk of cerebral
ischemia than carotid endarterectomy. We set out to compare cerebral h
emodynamics and microembolization during carotid PTA and CEA. Methods
We used transcranial Doppler to monitor the middle cerebral artery of
28 patients undergoing carotid PTA (n = 14) or carotid endarterectomy
(CEA) with a shunt (n = 14). Each period during which the internal car
otid artery was occluded by PTA balloon or by clamp when the shunt was
not in place was timed. Individual periods were summated to give a to
tal occlusion time. Ischemic time was defined as the period for which
mean middle cerebral artery velocity fell to a third or less of baseli
ne. Microembolic signals were counted during each procedure. Results C
EA resulted in significantly longer individual and total occlusion tim
e than PTA (mean individual occlusion time, seconds, CEA, 168 +/- 51;
PTA, 20 +/- 7; P < .001; mean total occlusion time; CEA, 337 +/- 70; P
TA, 26 +/- 10; P < .001. Ischemic time was also significantly longer d
uring CEA than during PTA (CEA, 165 +/- 40; PTA, 17 +/- 5; P = .001).
There were significantly more microembolic signals during PTA than dur
ing CEA (mean number of microembolic signals during CEA, 52 +/- 64; du
ring PTA, 202 +/- 119, P = .001). There was no correlation between any
of the parameters measured and periprocedural stroke, which occurred
in one patient in each group. Conclusion PTA results in less hemodynam
ic ischemia but more cerebral microembolism than CEA. In this small se
ries! however, it is not possible to comment on the relations between
ischemic time, microembolism, and stroke.