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

Year 2017, Volume: 3 Issue: 2, 188 - 195, 04.07.2017

Safa Gode , Seyma Denli Yalvac Murat Asik Ferit Ahmedov Onur Sen Kursat Oz Korhan Erkanli

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. 

Keywords

carotid endarterectomy, magnetic resonance imaging, cerebral embolism

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