Document Detail

The use of intraoperative monitoring and treatment of symptomatic microemboli in carotid artery stenting: case report and discussion.
MedLine Citation:
PMID:  17124612     Owner:  NLM     Status:  MEDLINE    
Carotid artery stenting is a recently introduced treatment in symptomatic atherosclerotic carotid artery disease with acceptable complication rates. The major risk is perioperative embolic stroke. Transcranial Doppler ultrasonography (TCD) can be used to identify embolic signals and guide therapy. We present a case of symptomatic embolization in a 72-year-old female following carotid stent deployment complicated by haemodynamic changes. Despite concurrent dual antiplatelet medication significant symptomatic embolization occurred even after restoration of the blood pressure, and modulation of the rate of embolization was achieved using dextran-40 guided by TCD monitoring. The patient recovered from an initially profound hemiparesis and dysphasia to minor sensory changes. Microemboli are common following carotid artery stenting and there appears to be a threshold phenomenon associated with prolonged embolization and progression to cerebral infarction. TCD can be used to detect particulate microemboli and therefore may be useful in guiding antithrombotic therapy in this setting. Dextran-40 has been shown to reduce the embolic load following carotid endarterectomy and was used to good effect in this patient in terms of both embolic load and clinical outcome. This is the first case of embolization following carotid stenting successfully treated with dextran-40, and offers a further option for therapeutic intervention in microembolism detected by TCD and stresses the importance of perioperative monitoring of embolic load for postoperative stroke risk.
P S Rangi; H S Markus; M N M Punter; A Clifton
Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-11-24
Journal Detail:
Title:  Neuroradiology     Volume:  49     ISSN:  0028-3940     ISO Abbreviation:  Neuroradiology     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-23     Completed Date:  2007-07-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1302751     Medline TA:  Neuroradiology     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  265-9     Citation Subset:  IM    
Department of Neuroradiology, Atkinson Morley Wing, St Georges Hospital, Blackshaw Road, Tooting, London, UK.
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MeSH Terms
Angiography, Digital Subtraction
Anticoagulants / therapeutic use
Carotid Stenosis / therapy*
Cerebral Angiography
Intracranial Embolism and Thrombosis / diagnosis,  prevention & control*
Magnetic Resonance Imaging
Monitoring, Intraoperative*
Ultrasonography, Doppler, Transcranial
Reg. No./Substance:

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