Doppler microembolic signals predict ischemic recurrences in symptomaticcarotid stenosis


Bruno Censori, Neurologia 2, Ospedali Riuniti, Largo Barozzi, 1, 24,100 Bergamo, Italy


Objective– To assess if Doppler microembolic signals (MES) associated with ≥60% symptomatic extracranial carotid stenosis may predict ischemic recurrences before endarterectomy or angioplasty. Methods– All patients with ≥60% carotid stenosis with symptoms in the preceding 2 months were prospectively considered. MES were identified using current criteria. All patients were followed-up until endarterectomy or angioplasty. Results– We studied 50 patients, at a median of 7 days from their last symptom. Twenty patients showed MES (40.0%); median embolus rate was 4/h. During a median follow-up of 19 days 7 patients had recurrences (transient monocular blindness=2; TIAs=4; stroke=1); 6 of them had shown MES. The association between recurrences and MES was significant (P=0.012). Conclusions– MES may identify patients with symptomatic carotid stenosis who are likely to suffer an ischemic recurrence before endarterectomy. This information may affect medical treatment and referral to the vascular surgeon.