Postprocedural microembolic events following carotid surgery and carotid angioplasty and stenting

Abstract

Although our early experience suggests that CAS may be performed safely (no permanent neurologic deficits following 27 consecutive procedures), cerebral microembolic events occurred in over two-thirds of the procedures despite the uniform use of distal protection. Open carotid surgery in this series seems to offer a lower risk of periprocedural microembolic events detected by DW-MRI.

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…[234][235][236][237][238][239][240][241][242] Subclinical ischemic injury has also been detected by MRI. 172,243,244 In the recent randomized trial ICSS (International Carotid Stenting Study), comparisons were possible between patients with CAS and CEA. These injuries, which presumably resulted from microembolism, were more frequent after CAS, as will be discussed further below.…”

Laboratory-Based Markers as Predictors of Brain Infarction During Carotid Stenting: a Prospective Study

“…going CAS [9][10][11]29) . These new lesions have been found not only in the ipsilateral hemisphere but also in the contralateral hemisphere or in the posterior circulation [30][31][32] . In accordance with our results, other studies have demonstrated that most of the new ischemic lesions in the brain detected by DWI after CAS were asymptomatic and that few patients developed TIA or stroke 11,29) .…”

“…Among vascular risk factors, only coronary artery disease has been identified as a significant predictor of microembolism after CAS 23) . Main documented risk factors associated with periprocedural risk of embolization are excessive manipulation with CAS devices 35) , plaque instability 36) , anatomic abnormalities (particularly tortuosity of the aortic arch and carotid artery) 30,32) , and atherosclerotic aortic plaques 30,37) . In (Cont Table 2 were selected on the basis of the literature and widely used laboratory tests.…”

Advances in Interventional Neuroradiology 2007

“…8 A pre-/post-MRI study of diffusionweighted imaging changes after CAS with distal embolic protection device or CEA found lesions in 70% of CAS-distal embolic protection device patients and in none of the CEA patients. 9 Among the CAS patients, diffusion-weighted imaging lesions relative to the vessel treated were either bilateral (36%), ipsilateral (47%), or contralateral (16%), and neurological symptoms lasting Ͼ36 hours occurred in 11%. 9 A protocol for comprehensive blood pressure management initiated in conjunction with CAS was shown to significantly reduce the incidence of intracerebral hemorrhage in all patients and both hyperperfusion syndrome and intracerebral hemorrhage in high-risk patients.…”

“…9 Among the CAS patients, diffusion-weighted imaging lesions relative to the vessel treated were either bilateral (36%), ipsilateral (47%), or contralateral (16%), and neurological symptoms lasting Ͼ36 hours occurred in 11%. 9 A protocol for comprehensive blood pressure management initiated in conjunction with CAS was shown to significantly reduce the incidence of intracerebral hemorrhage in all patients and both hyperperfusion syndrome and intracerebral hemorrhage in high-risk patients. 10 A number of industry supported registries continue to supply interesting data.…”