Characteristics of cerebral microembolism during carotid stenting and angioplasty alone

Background: Cerebral microembolism has often been documented by transcrania l Doppler imaging during carotid angioplasty and stenting. However, few dat a are available about its characteristics during the 2 different kinds of p rocedure. Objectives: To compare the incidence of microemboli occurring during angiop lasty alone with that during stenting in the different phases of the proced ures and to relate it to periprocedural cerebrovascular complications. Patients and Methods: Thirty-eight patients underwent 41 procedures (15 ang ioplasty alone and 26 stenting) for symptomatic carotid stenoses of 70% or more. Transcranial Doppler monitoring was performed to detect microemboli i n the middle cerebral artery during 3 phases of the procedure: (1) guidewir e crossing, (2) first dilatation in case of angioplasty alone or stent rele ase with predilatation if performed, and (3) further dilatation. Results: Microemboli occurred in all cases in phase 1 of the procedure but less frequently in the arteries treated with stenting when compared with th ose treated with angioplasty alone in phase 2 and particularly (P < .02) in phase 3. The mean number of microemboli was highest in phase 2, predominan t (P < .05) during angioplasty alone, and particularly reduced (P < .02) in phase 3 during the stenting procedures. During 2 (5%) of the 41 procedures , cerebrovascular complications occurred in phase 1, with the number of mic roemboli being higher than mean values. Conclusions: Cerebral microembolism is a very common event, especially duri ng guidewire crossing and angioplasty alone compared with stenting. Further studies concerning the prognostic significance of this are advisable.