| Comparison of hemodynamic cerebral ischemia and microembolic signals detected during carotid endarterectomy and carotid angioplasty. | |
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MedLine Citation:
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PMID: 9412633 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: There has been concern about carotid percutaneous transluminal angioplasty (PTA) carrying a greater risk of cerebral ischemia than carotid endarterectomy. We set out to compare cerebral hemodynamics and microembolization during carotid PTA and CEA. METHODS: We used transcranial Doppler to monitor the middle cerebral artery of 28 patients undergoing carotid PTA (n = 14) or carotid endarterectomy (CEA) with a shunt (n = 14). Each period during which the internal carotid artery was occluded by PTA balloon or by clamp when the shunt was not in place was timed. Individual periods were summated to give a total occlusion time. Ischemic time was defined as the period for which mean middle cerebral artery velocity fell to a third or less of baseline. Microembolic signals were counted during each procedure. RESULTS: CEA resulted in significantly longer individual and total occlusion time than PTA (mean individual occlusion time, seconds), CEA, 168 +/- 51; PTA, 20 +/- 7; P < .001; mean total occlusion time; CEA, 337 +/- 70; PTA, 26 +/- 10; P < .001. Ischemic time was also significantly longer during CEA than during PTA (CEA, 165 +/- 40; PTA, 17 +/- 5; P = .001). There were significantly more microembolic signals during PTA than during CEA (mean number of microembolic signals during CEA, 52 +/- 64; during PTA, 202 +/- 119; P = .001). There was no correlation between any of the parameters measured and periprocedural stroke, which occurred in one patient in each group. CONCLUSION: PTA results in less hemodynamic ischemia but more cerebral microembolism than CEA. In this small series, however, it is not possible to comment on the relations between ischemic time, microembolism, and stroke. |
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Authors:
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F Crawley; A Clifton; T Buckenham; T Loosemore; R S Taylor; M M Brown |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 28 ISSN: 0039-2499 ISO Abbreviation: Stroke Publication Date: 1997 Dec |
Date Detail:
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Created Date: 1998-01-23 Completed Date: 1998-01-23 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 2460-4 Citation Subset: IM |
Affiliation:
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Division of Clinical Neuroscience, St George's Hospital Medical School, London, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary* Blood Flow Velocity / physiology Brain Ischemia / physiopathology*, ultrasonography Carotid Stenosis / physiopathology, therapy* Endarterectomy* Hemodynamics / physiology* Humans Intracranial Embolism and Thrombosis / physiopathology*, ultrasonography Middle Aged Monitoring, Intraoperative Time Factors Ultrasonography, Doppler, Transcranial |
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