Stroke, Vol 21, 415-423, Copyright © 1990 by American Heart Association
MP Spencer, GI Thomas, SC Nicholls and LR Sauvage
The purpose of our study was to define the signal characteristics and
clinical circumstances associated with emboli detected in the middle
cerebral artery using 2-MHz pulsed transcranial Doppler ultrasound in
patients undergoing carotid endarterectomy. Signals designating emboli were
transients displaying harmonic qualities the signatures of which were
clearly different from those of mechanical and electronic artifacts. We
reviewed the audio/video tape recordings from 91 patients for signals of
air bubble emboli occurring upon release of common carotid artery
crossclamps; recordings from 35 patients (38%) demonstrated air bubble
emboli. Transients with signatures identical to those of air bubble emboli
were also discovered when bubbles in the bloodstream were improbable; we
defined these transients as representing formed-element emboli. Such
signals were found in recordings from 24 patients (26%), and they occurred
before (both spontaneously and upon common carotid artery compression),
during, and after surgical dissection. Signals indicating formed-element
emboli were associated with intraluminal platelet thrombus, with
ulcerations in the carotid artery, and with transient ischemic attacks or
stroke. Most postoperative formed-element emboli did not cause symptoms
but, when persisting for hours, they were associated with strokes and
cerebral infarction. This Doppler ultrasound method of detecting emboli
will be useful in the study of stroke mechanisms and as a clinical test to
guide the medical and surgical treatment of patients at risk of stroke.
ARTICLES
Detection of middle cerebral artery emboli during carotid endarterectomy using transcranial Doppler ultrasonography
Providence Medical Center, Seattle, Washington.
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