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Characteristics of Cerebral Microembolism During Carotid Stenting and Angioplasty Alone
Giovanni Orlandi, MD;
Simona Fanucchi, MD;
Cristina Fioretti, MD;
Giovanni Acerbi, MD;
Michele Puglioli, MD;
Riccardo Padolecchia, MD;
Ferdinando Sartucci, MD;
Luigi Murri, MD
Arch Neurol. 2001;58:1410-1413.
Background Cerebral microembolism has often been documented by transcranial Doppler
imaging during carotid angioplasty and stenting. However, few data are available
about its characteristics during the 2 different kinds of procedure.
Objectives To compare the incidence of microemboli occurring during angioplasty
alone with that during stenting in the different phases of the procedures
and to relate it to periprocedural cerebrovascular complications.
Patients and Methods Thirty-eight patients underwent 41 procedures (15 angioplasty alone
and 26 stenting) for symptomatic carotid stenoses of 70% or more. Transcranial
Doppler monitoring was performed to detect microemboli in the middle cerebral
artery during 3 phases of the procedure: (1) guidewire crossing, (2) first
dilatation in case of angioplasty alone or stent release 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 those
treated with angioplasty alone in phase 2 and particularly (P<.02) in phase 3. The mean number of microemboli was highest in
phase 2, predominant (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 microemboli being higher
than mean values.
Conclusions Cerebral microembolism is a very common event, especially during guidewire
crossing and angioplasty alone compared with stenting. Further studies concerning
the prognostic significance of this are advisable.
From the Department of Neuroscience (Drs Orlandi, Fanucchi, Fioretti,
Acerbi, Sartucci, and Murri) and the Unit of Neuroradiology (Drs Puglioli
and Padolecchia), University of Pisa, Pisa, Italy.
Corresponding author and reprints: Giovanni Orlandi, MD, Department
of Neuroscience, Clinic of Neurology, Via Roma 67, 56100 Pisa, Italy (e-mail:
g.orlandi{at}neuro.med.unipi.it).
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