Key result
Endovascular techniques without protection devices linked to >8 times more microemboli than carotid endarterectomy.
Why the study?
Embolization during carotid reconstruction is the most frequent cause of neurologic complications, and techniques to reduce this risk need to be evaluated.
Effect estimate: > 8 times
Highlights the necessity of cerebral protection during carotid stenting due to a significantly higher risk of microemboli compared to endarterectomy.
Cautious use of unprotected endovascular carotid techniques advised; leaves open randomized trials confirming embolic protection benefit.
-Embolization during carotid reconstruction is the most frequent cause of neurologic complications. Atraumatic surgical technique, intraoperative monitoring of the cerebral circulation and completion imaging all contribute to reduce the risks of embolization. Data from the literature suggest that the incidence of perioperative neurologic events correlate with the number of microemboli demonstrated by transcranial Doppler. Cerebral protection for percutaneous angioplasty with stenting of the carotid artery needs to be introduced, since without protection devices endovascular techniques are associated with > 8 times the rate of microemboli seen during carotid endarterectomy. KEYWORD Carotid endarterectomy - stroke - cerebral microemboli - carotid stenting - angioplasty
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Gloviczki et al. (2001) conducted a review in Carotid artery disease. Percutaneous angioplasty with stenting without protection devices vs. Carotid endarterectomy was evaluated on Microemboli (> 8 times). Endovascular techniques without protection devices are associated with >8 times the rate of microemboli compared to carotid endarterectomy.
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