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(Stroke. 2004;35:e373.)
© 2004 American Heart Association, Inc.

Research Reports

Microembolic Signals Detected by Transcranial Doppler Sonography During Carotid Endarterectomy and Correlation With Serial Diffusion-Weighted Imaging

Oliver Wolf, MD; Peter Heider, MD; Marco Heinz; Holger Poppert, MD; Dirk Sander, MD PhD; Oliver Greil, MD; Wolfgang Weiss, MD; Marc Hanke, MD Hans-Henning Eckstein, MD PhD

From the Departments of Vascular Surgery (O.W., P.H., M. Heinz, M. Hanke, H.-H.E.), Neurology (H.P., D.S.), and Radiology (O.G., W.W.), Technical University of Munich, Germany.

Correspondence to Dr Oliver Wolf, Technical University of Munich, Rechts der Isar Medical Center, Department of Vascular Surgery, Ismaninger Strasse 22, 81675 München, Germany. E-mail wolfdr2{at}hotmail.com

Background and Purpose— Embolic events are a major cause for procedure-related strokes after carotid endarterectomy (CEA). Transcranial Doppler sonography can reveal embolic events as microembolic signals (MES) during CEA. MES during declamping and shunting are frequently detected. MES during shunting are rare and known to be correlated with the neurological outcome of the patient. In the present study, we analyzed the occurrence of MES within different stages of CEA and whether MES within those stages were correlated with cerebral ischemia, as detected by diffusion-weighted imaging (DWI), and brain infarction, as detected by contrast-enhanced MRI.

Methods— Thirty-three patients were monitored intraoperatively for MES using transcranial Doppler sonography. DWI was performed within 24 hours before and after surgery. Positive postoperative DWI led to reexamination with contrast-enhanced T1-MRI 7 to 10 days after CEA for detection of cerebral infarction.

Results— MES were detected in 32 of 33 patients. The highest number of MES was found during shunting and declamping. A significant correlation was found between MES and DWI-lesions during dissection. A significant correlation was found between MES during dissection and shunting, and nonsignificant correlation was found between MES and the occurrence of cerebral infarction.

Conclusion— MES could be regularly detected during CEA. Dissection and shunting seem to be the most vulnerable stages of the procedure.

Key Words: carotid endarterectomy • carotid stenosis • cerebral embolism • magnetic resonance imaging

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