This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stork, J. L. Articles by Donnan, G. A. Search for Related Content PubMed PubMed Citation Articles by Stork, J. L. Articles by Donnan, G. A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Stroke Related Collections Carotid endarterectomy Carotid Stenosis Embolic stroke Doppler ultrasound, Transcranial Doppler etc.

(Stroke. 2002;33:2082.)
© 2002 American Heart Association, Inc.

Original Contributions

Possible Determinants of Early Microembolism After Carotid Endarterectomy

Jacinda L. Stork, BAppSci(Hons); Christopher R. Levi, MBBS; Brian R. Chambers, MD; Anne L. Abbott, MBBS Geoffrey A. Donnan, MD

From the National Stroke Research Institute (J.L.S., B.R.C., A.L.A., G.A.D.) and Neurology Department (B.R.C., G.A.D.), Austin and Repatriation Medical Centre, West Heidelberg; University of Melbourne, Department of Medicine, Parkville (J.L.S., B.R.C., A.L.A., G.A.D.); and Department of Neuroscience, John Hunter Hospital, Newcastle (C.R.L.), Australia.

Correspondence to Professor Geoffrey A. Donnan, National Stroke Research Institute, Repatriation Campus, Austin and Repatriation Medical Centre, Banksia St, West Heidelberg, Victoria 3081, Australia. E-mail amm{at}austin.unimelb.edu.au

Background and Purpose— High numbers of microembolic signals (MES) have been associated with increased risk of postoperative stroke after carotid endarterectomy (CEA). We sought to identify factors predictive of postoperative MES.

Methods— Transcranial Doppler monitoring of the ipsilateral middle cerebral artery for MES was performed for 30 minutes during the first postoperative hour in sequential patients undergoing CEA. Stepwise binomial logistic regression analysis was performed to identify preoperative and intraoperative variables that predicted the occurrence of postoperative MES.

Results— We studied 141 patients (mean age, 69 years); 102 (72%) were male, and 69 (49%) had at least 1 MES (range, 1 to 118) detected in the first postoperative hour. The risk of postoperative MES was greater in women (P=0.027), patients not receiving antiplatelet therapy (P=0.033), and patients undergoing left-sided CEA (P=0.049). Other variables such as residual stenosis seen on completion angiography and operative technique were not associated with postoperative MES.

Conclusions— Postoperative MES were most likely in women, patients not receiving preoperative antiplatelet therapy, and patients who had a left CEA. Microembolism might explain why these same factors are associated with higher rates of perioperative stroke.

Key Words: carotid endarterectomy • carotid stenosis • middle cerebral artery • ultrasonography, Doppler, transcranial

This article has been cited by other articles:

				M. J. Martin, E. M.L. Chung, A. H. Goodall, A. D. Martina, K. V. Ramnarine, L. Fan, S. V. Hainsworth, A. R. Naylor, and D. H. Evans Enhanced Detection of Thromboemboli With the Use of Targeted Microbubbles Stroke, October 1, 2007; 38(10): 2726 - 2732. [Abstract] [Full Text] [PDF]

				M. A. Sloan, A. V. Alexandrov, C. H. Tegeler, M. P. Spencer, L. R. Caplan, E. Feldmann, L. R. Wechsler, D. W. Newell, C. R. Gomez, V. L. Babikian, et al. Assessment: Transcranial Doppler ultrasonography: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology, May 11, 2004; 62(9): 1468 - 1481. [Abstract] [Full Text] [PDF]

				B. Cucchiara and S. Messe Affected Side and Risk of Pain Recurrence After Surgery for Trigeminal Neuralgia Arch Neurol, August 1, 2003; 60(8): 1169 - 1170. [Full Text] [PDF]