Doppler microembolic signals predict ischemic recurrences in symptomatic carotid stenosis

Objective - To assess if Doppler microembolic signals (MES) associated with greater than or equal to 60% symptomatic extracranial carotid stenosis may predict ischemic recurrences before endarterectomy or angioplasty. Methods - All patients with greater than or equal to 60% carotid stenosis with sym ptoms in the preceding 2 months were prospectively considered. MES were ide ntified using current criteria. All patients were followed-up until endarte rectomy or angioplasty. Results - We studied 50 patients, at a median of 7 days from their last symptom. Twenty patients showed MES (40.0%); median em bolus rate was 4/h. During a median follow-up of 19 days 7 patients had rec urrences (transient monocular blindness = 2; TIAs = 4; stroke = 1); 6 of th em had shown MES. The association between recurrences and MES was significa nt (P = 0.012). Conclusions - MES may identify patients with symptomatic ca rotid stenosis who are likely to suffer an ischemic recurrence before endar terectomy. This information may affect medical treatment and referral to th e vascular surgeon.