Key result
Recent ischemic symptoms in patients with high-grade internal carotid artery stenosis were associated with a higher mean rate of silent microembolic events (14/h) versus asymptomatic patients (0.35/h).
Why the study?
Does the rate of TCD-detected silent microembolism differ between symptomatic and asymptomatic patients with high-grade internal carotid artery stenosis?
Observational (n=89)
Does the rate of TCD-detected silent microembolism differ between symptomatic and asymptomatic patients with high-grade internal carotid artery stenosis?
Absolute Event Rate: 14% vs 0.35%
TCD monitoring of silent microembolism can identify unstable internal carotid artery disease, strongly correlating with recent ischemic symptoms.
TCD microembolism rates may stratify carotid stenosis risk; leaves open whether monitoring improves outcomes or decisions.
Using transcranial Doppler (TCD) ultrasonography in patients with high-grade (> or = 70%) internal carotid artery (ICA) stenosis, we examined the relation between the rate of TCD-detected silent microembolism of the ipsilateral middle cerebral artery and a history of recent (< 121 days) ischemic symptoms attributable to the diseased ICA. In the so-defined neurologically symptomatic group (n = 33 patients), silent microembolic events occurred in 27 subjects (overall mean rate, 14/h +/- 29). Among 56 neurologically asymptomatic patients matched for the degree of ICA stenosis, only nine showed such events (overall mean rate, 0.35/h +/- 1.4). Across all 89 patients studied, an individual microembolic event rate > or = 2/h had a positive predictive value of 0.88 for a history of recent symptoms. Our data suggest that TCD monitoring can provide reliable paraclinical evidence of "unstable ICA disease."
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Siebler et al. (1994) conducted an observational in High-grade internal carotid artery stenosis (n=89). Recent (< 121 days) ischemic symptoms vs. Neurologically asymptomatic was evaluated on Rate of TCD-detected silent microembolism of the ipsilateral middle cerebral artery. Recent ischemic symptoms in patients with high-grade internal carotid artery stenosis were associated with a higher mean rate of silent microembolic events (14/h) versus asymptomatic patients (0.35/h).
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