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Year 2017, Volume: 3 Issue: 2, 188 - 195, 04.07.2017
https://doi.org/10.18621/eurj.284652

Abstract

References

  • [1] Fairhead JF, Rothwell PM. The need for urgency in identification and treatment of symptomatic carotid stenosis is already established. Cerebrovasc Dis 2005;19:355-8.
  • [2] Walker MD, Marler JR, Goldstein M, Grady PA, Toole JF, Baker WH, et al. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995;273:1421-8.
  • [3] Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, et al; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet 2004;363:1491-502.
  • [4] North American Symptomatic Carotid Endarterectomy Trial Collaborators; Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445-53.
  • [5] Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T, et al. Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the ad hoc committee. American Heart Association. Stroke 1995;26:188-201.
  • [6] Biller J, Feinberg WM, Castaldo JE, Whittemore AD, Harbaugh RE, Dempsey RJ, et al. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a special writing group of the Stroke Council. American Heart Association. Stroke 1998;29:554-62.
  • [7] Cantelmo NL, Babikian VL, Samaraweera RN, Gordon JIC, Pochay VE, Winter ML. Cerebral microembolism and ischemic changes associated with carotid endarterectomy. J Vasc Surg 1998;27:1024-31.
  • [8] Jansen C, Ramos LM, van Heesewijk JP, Moll FL, van Gijn J, Ackerstaff RG. Impact of microembolism and hemodynamic changes in the brain during carotid endarterectomy. Stroke 1994;25:992-7.
  • [9] Muller M, Reiche W, Langenscheidt P, Hassfeld J, Hagen T. Ischemia after carotid endarterectomy: comparison between transcranial Doppler sonography and diffusion-weighted MR imaging. AJNR Am J Neuroradiol 2000;21:47-54.
  • [10] Schroeder AP, Falk E. Vulnerable and dangerous coronary plaques. Atherosclerosis 1995;118:141-9.
  • [11] Pasterkamp G, Schoneveld AH, van der Wal AC, Haudenschild CC, Clarijs RJ, Becker AE, et al. Relation of arterial geometry to luminal narrowing and histologic markers for plaque vulnerability: the remodeling paradox. J Am Coll Cardiol 1998;32:655-62.
  • [12] Kolodgie FD, Gold HK, Burke AP, Fowler DR, Kruth HS, Weber DK, et al. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 2003;349:2316-25.
  • [13] Moseley ME, Kucharczyk J, Mintorovitch J, Cohen Y, Kurhanewicz J, Derugin N, et al. Diffusion weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats. AJNR Am J Neuroradiol 1990;11:423-9.
  • [14] European Carotid Surgery Trialists’ Collaboratory Group; Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998;351:1379-87.
  • [15] Rapp JH, Wakil L, Sawhney R, Pan XM, Yenari MA, Glastonbury C, et al. Subclinical embolization after carotid artery stenting: new lesions on diffusion-weighted magnetic resonance imaging occur postprocedure. J Vasc Surg 2007;45:867-72.
  • [16] Tedesco MM, Lee JT, Dalman RL, Lane B, Loh C, Haukoos JS, et al. Postprocedural microembolic events following carotid surgery and carotid angioplasty and stenting. J Vasc Surg 2007;46:244-50.
  • [17] Forbes KP, Shill HA, Britt PM, Zabramski JM, Spetzler RF, Heiserman JE. Assessment of silent embolism from carotid endarterectomy by use of diffusionweighted imaging: work in progress. AJNR Am J Neuroradiol 2001;22:650-3.
  • [18] Feiwell RJ, Besmertis L, Sarkar R, Saloner DA, Rapp JH. Detection of clinically silent infarcts after carotid endarterectomy by use of diffusion weighted imaging. AJNR Am J Neuroradiol 2001;22:646-9.
  • [19] Barth A, Remonda L, Lovblad KO, Schroth G, Seiler RW. Silent cerebral ischemia detected by diffusion-weighted MRI after carotid endarterectomy. Stroke 2000;31:1824-8.
  • [20] Van Everdingen KJ, van der Grond J, Kappelle LJ, Ramos LM, Mali WP. Diffusion-weighted magnetic resonance imaging in acute stroke. Stroke 1998;29:1783-90.
  • [21] Bryan RN, Levy LM, Whitlow WD, Killian JM, Preziosi TJ, Rosario JA. Diagnosis of acute cerebral infarction: comparison of CT and MR imaging. AJNR Am J Neuroradiol 1991;12:611-62.
  • [22] Verhoeven BA, de Vries JP, Pasterkamp G, Ackerstaff RG, Schoneveld AH, Velema E, et al. Carotid atherosclerotic plaque characteristics are associated with microembolization during carotid endarterectomy and procedural outcome. Stroke 2005;36:1735-40.
  • [23] Aksun M, Girgin S, Kuru V, Sencan A, Yilik L, Aran G, et al. Cerebral oximetry monitoring method for the evaluation of the need of shunt placement during carotid endarterectomy. Turk Gogus Kalp Dama 2013;21:1152-5.
  • [24] Schnaudigel S, Groschel K, Pilgram SM, Kastrup A. New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 2008;39:1911-9.
  • [25] Toktas F, Goncu T, Surer S, Yumun G, Ozsin KK, Erdolu B, et al. Carotid endarterectomy: a comparison on general and local anesthesia. Eur Res J 2015;1:39-43.
  • [26] Gaunt ME, Brown L, Hartshorne T, Bell PR, Naylor AR. Unstable carotid plaques: preoperative identification and association with intraoperative embolization detected by transcranial Doppler. Eur J Vasc Endovasc Surg 1996;11:78-82.
  • [27] Weiller C, Ringelstein EB, Reiche W, Buell U. Clinical and hemodynamic aspects of low flow infracts. Stroke 1991;22:1117-23.
  • [28] Momjian-Mayor I, Baron JC. The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies. Stroke 2005;36:567-77.
  • [29] Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998;55:1475-82.
  • [30] Stoneham MD, Thompson JP. Arterial pressure management and carotid endarterectomy. Br J Anaesth 2009;102:442-52.

Silent cerebral embolism after carotid endarterectomy: a two-center experience

Year 2017, Volume: 3 Issue: 2, 188 - 195, 04.07.2017
https://doi.org/10.18621/eurj.284652

Abstract

Objectives. Carotid endarterectomy (CEA)
is considered the most effective treatment for stroke prevention in patients
with critical carotid stenosis. The incidence of new ischemic lesions ranges
from 0% to 33% at diffusion-weighted magnetic resonance imaging (DW-MRI) after
CEA in previous studies. We determined the rate of silent cerebral embolism in
CEA patients by DW-MRI in this study. Methods.
This study was conducted between January 2016 and April 2016 in two centers.
Thirty-five consecutive patients (three with bilateral) with 38 CEAs were
included in the study. There were no new postoperative symptoms in all patients.
Preoperative and postoperative brain DW-MRIs were performed within one day
preoperatively and second day postoperatively. Two DW-MRIs were screened and
compared in terms of newly occurring lesions. Thus, we attempted to find the
rate of silent cerebral embolism. Results.
New brain lesions were detected in six (6/38 CEAs; 15.8%) cases with unilateral
CEAs. All of these lesions were ischemic. In five cases, new lesions were
located within the operated carotid artery territory (ipsilateral parietal
lobe). However, in one case, a new lesion was located outside of the operated
carotid artery territory (ipsilateral occipital lobe). Thirty-day morbidity and
mortality rates were 0% and 2.85% (1/35), respectively. Conclusion. Silent cerebral embolisms may frequently occur
during postoperative period in CEA patients. Even if these lesions are
asymptomatic, we have to be rigorous to avoid microembolism during all stages
during surgery. 

References

  • [1] Fairhead JF, Rothwell PM. The need for urgency in identification and treatment of symptomatic carotid stenosis is already established. Cerebrovasc Dis 2005;19:355-8.
  • [2] Walker MD, Marler JR, Goldstein M, Grady PA, Toole JF, Baker WH, et al. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995;273:1421-8.
  • [3] Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, et al; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet 2004;363:1491-502.
  • [4] North American Symptomatic Carotid Endarterectomy Trial Collaborators; Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445-53.
  • [5] Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T, et al. Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the ad hoc committee. American Heart Association. Stroke 1995;26:188-201.
  • [6] Biller J, Feinberg WM, Castaldo JE, Whittemore AD, Harbaugh RE, Dempsey RJ, et al. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a special writing group of the Stroke Council. American Heart Association. Stroke 1998;29:554-62.
  • [7] Cantelmo NL, Babikian VL, Samaraweera RN, Gordon JIC, Pochay VE, Winter ML. Cerebral microembolism and ischemic changes associated with carotid endarterectomy. J Vasc Surg 1998;27:1024-31.
  • [8] Jansen C, Ramos LM, van Heesewijk JP, Moll FL, van Gijn J, Ackerstaff RG. Impact of microembolism and hemodynamic changes in the brain during carotid endarterectomy. Stroke 1994;25:992-7.
  • [9] Muller M, Reiche W, Langenscheidt P, Hassfeld J, Hagen T. Ischemia after carotid endarterectomy: comparison between transcranial Doppler sonography and diffusion-weighted MR imaging. AJNR Am J Neuroradiol 2000;21:47-54.
  • [10] Schroeder AP, Falk E. Vulnerable and dangerous coronary plaques. Atherosclerosis 1995;118:141-9.
  • [11] Pasterkamp G, Schoneveld AH, van der Wal AC, Haudenschild CC, Clarijs RJ, Becker AE, et al. Relation of arterial geometry to luminal narrowing and histologic markers for plaque vulnerability: the remodeling paradox. J Am Coll Cardiol 1998;32:655-62.
  • [12] Kolodgie FD, Gold HK, Burke AP, Fowler DR, Kruth HS, Weber DK, et al. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 2003;349:2316-25.
  • [13] Moseley ME, Kucharczyk J, Mintorovitch J, Cohen Y, Kurhanewicz J, Derugin N, et al. Diffusion weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats. AJNR Am J Neuroradiol 1990;11:423-9.
  • [14] European Carotid Surgery Trialists’ Collaboratory Group; Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998;351:1379-87.
  • [15] Rapp JH, Wakil L, Sawhney R, Pan XM, Yenari MA, Glastonbury C, et al. Subclinical embolization after carotid artery stenting: new lesions on diffusion-weighted magnetic resonance imaging occur postprocedure. J Vasc Surg 2007;45:867-72.
  • [16] Tedesco MM, Lee JT, Dalman RL, Lane B, Loh C, Haukoos JS, et al. Postprocedural microembolic events following carotid surgery and carotid angioplasty and stenting. J Vasc Surg 2007;46:244-50.
  • [17] Forbes KP, Shill HA, Britt PM, Zabramski JM, Spetzler RF, Heiserman JE. Assessment of silent embolism from carotid endarterectomy by use of diffusionweighted imaging: work in progress. AJNR Am J Neuroradiol 2001;22:650-3.
  • [18] Feiwell RJ, Besmertis L, Sarkar R, Saloner DA, Rapp JH. Detection of clinically silent infarcts after carotid endarterectomy by use of diffusion weighted imaging. AJNR Am J Neuroradiol 2001;22:646-9.
  • [19] Barth A, Remonda L, Lovblad KO, Schroth G, Seiler RW. Silent cerebral ischemia detected by diffusion-weighted MRI after carotid endarterectomy. Stroke 2000;31:1824-8.
  • [20] Van Everdingen KJ, van der Grond J, Kappelle LJ, Ramos LM, Mali WP. Diffusion-weighted magnetic resonance imaging in acute stroke. Stroke 1998;29:1783-90.
  • [21] Bryan RN, Levy LM, Whitlow WD, Killian JM, Preziosi TJ, Rosario JA. Diagnosis of acute cerebral infarction: comparison of CT and MR imaging. AJNR Am J Neuroradiol 1991;12:611-62.
  • [22] Verhoeven BA, de Vries JP, Pasterkamp G, Ackerstaff RG, Schoneveld AH, Velema E, et al. Carotid atherosclerotic plaque characteristics are associated with microembolization during carotid endarterectomy and procedural outcome. Stroke 2005;36:1735-40.
  • [23] Aksun M, Girgin S, Kuru V, Sencan A, Yilik L, Aran G, et al. Cerebral oximetry monitoring method for the evaluation of the need of shunt placement during carotid endarterectomy. Turk Gogus Kalp Dama 2013;21:1152-5.
  • [24] Schnaudigel S, Groschel K, Pilgram SM, Kastrup A. New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 2008;39:1911-9.
  • [25] Toktas F, Goncu T, Surer S, Yumun G, Ozsin KK, Erdolu B, et al. Carotid endarterectomy: a comparison on general and local anesthesia. Eur Res J 2015;1:39-43.
  • [26] Gaunt ME, Brown L, Hartshorne T, Bell PR, Naylor AR. Unstable carotid plaques: preoperative identification and association with intraoperative embolization detected by transcranial Doppler. Eur J Vasc Endovasc Surg 1996;11:78-82.
  • [27] Weiller C, Ringelstein EB, Reiche W, Buell U. Clinical and hemodynamic aspects of low flow infracts. Stroke 1991;22:1117-23.
  • [28] Momjian-Mayor I, Baron JC. The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies. Stroke 2005;36:567-77.
  • [29] Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998;55:1475-82.
  • [30] Stoneham MD, Thompson JP. Arterial pressure management and carotid endarterectomy. Br J Anaesth 2009;102:442-52.
There are 30 citations in total.

Details

Subjects Health Care Administration
Journal Section Original Articles
Authors

Safa Gode

Seyma Denli Yalvac This is me

Murat Asik This is me

Ferit Ahmedov This is me

Onur Sen This is me

Kursat Oz This is me

Korhan Erkanli This is me

Publication Date July 4, 2017
Submission Date January 6, 2017
Acceptance Date March 27, 2017
Published in Issue Year 2017 Volume: 3 Issue: 2

Cite

AMA Gode S, Denli Yalvac S, Asik M, Ahmedov F, Sen O, Oz K, Erkanli K. Silent cerebral embolism after carotid endarterectomy: a two-center experience. Eur Res J. July 2017;3(2):188-195. doi:10.18621/eurj.284652

e-ISSN: 2149-3189 


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