The Relationship of Carotid Artery Plaque and Stenosis with Microemboli
Article Sidebar
Main Article Content
Abstract
Objective: Microembolic signals (MES) are markers that can be detected by Transcranial Doppler Ultrasonography (TCD) and are risk factors for stroke. The aim of our study is to explore the relationship between the number of MES and the extent of carotid stenosis as well as plaque morphology. Our goal is to provide a fresh perspective on the treatment of carotid stenosis.
Materials and Methods: A total of 95 patients, who were admitted to the emergency department of Sultan 2.Abdülhamid Han Training and Research Hospital and were hospitalized with a diagnosis of stroke, were enrolled in the study. Patients with high-risk cardiac diseases were excluded from the study. Detailed medical histories, risk factors, and current medical treatments of the patients were documented, and microemboli detection was conducted using Transcranial Doppler (TCD). The number of microemboli in TCD was obtained by averaging the results of 2 consecutive half-hour follow-ups in a region. Carotid stenosis rates of the patients were determined by computed tomography angiography (CTA) according to the North American Symptomatic Endarterectomy Trial (NASCET) classification, and the plaque morphology was determined according to the Gray-Weale scale of carotid ultrasonography. Patients were categorized into symptomatic and asymptomatic carotid stenosis groups, and the number of microembolic signals (MES) was compared between these groups.
Result: MES numbers of 95 patients with symptomatic carotid stenosis; while MES was not detected in 47.4% (n=45); 35.8% (n=34) had 1-2 MES, 8.4% (n=8) had 3-4 MES and 8.4% (n=8) 5 or more MES were detected. The relationship between the MES obtained and carotid stenosis was statistically significant (p<0.001).
According to the type of plaque; while there is no MES in 68.2% (n=15) of Type-4 symptomatic stenosis, this rate is only 15% (n=3) in Type-1 stenosis. In addition, 20% (n=4) of Type-1 symptomatic stenosis had MES between 3-4 and 30% (n=6) of 5 or more MES. According to these results, the relationship between plaque type and the presence of MES is statistically significant. (p<0.001) Similar results were obtained in asymptomatic carotid stenosis.
Conclusion: TCD is an easy-to-apply, non-invasive imaging technique, and MES detectable by TCD are risk factors for stroke. The relationship between MES and carotid stenosis rate and plaque type heterogeneity is statistically significant.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2023-10-26
Published 2023-10-26
References
Feigin VL, Krishnamurthi R V., Parmar P, Norrving B, Mensah GA, Bennett DA, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: The GBD 2013 study. Neuroepidemiology. 2015;45(3):161–76. DOI: https://doi.org/10.1159/000441085
M. A. No Title. Beyin Damar Hast ve Demans. (Ulusal Hastalık Yükü Çalışması Sonuçları ve Çözümleri).
Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics - 2018 update: A report from the American Heart Association. Vol. 137, Circulation. 2018. 67–492 p. DOI: https://doi.org/10.1161/CIR.0000000000000573
Asymptomatic MRC, Surgery C, Acst T, Group C. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: Randomised controlled trial. Lancet. 2004;363(9420):1491–502. DOI: https://doi.org/10.1016/S0140-6736(04)16146-1
Dharmakidari S, Bhattacharya P, Chaturvedi S. Carotid Artery Stenosis: Medical Therapy, Surgery, and Stenting. Curr Neurol Neurosci Rep. 2017;17(10):1–7. DOI: https://doi.org/10.1007/s11910-017-0786-2
Rothwell PM, Goldstein LB. Carotid endarterectomy for asymptomatic carotid stenosis: Asymptomatic carotid surgery trial. Stroke. 2004;35(10):2425–7. DOI: https://doi.org/10.1161/01.STR.0000141706.50170.a7
Paraskevas KI, Spence JD, Veith FJ, Nicolaides AN. Identifying which patients with asymptomatic carotid stenosis could benefit from intervention. Stroke. 2014;45(12):3720–4. DOI: https://doi.org/10.1161/STROKEAHA.114.006912
Spence JD, Tamayo A, Lownie SP, Ng WP, Ferguson GG. Absence of microemboli on transcranial Doppler identifies low-risk patients with asymptomatic carotid stenosis. Stroke. 2005;36(11):2373–8. DOI: https://doi.org/10.1161/01.STR.0000185922.49809.46
Censori B, Partziguian T, Casto L, Camerlingo M, Mamoli A. Doppler microembolic signals predict ischemic recurrences in symptomatic carotid stenosis. Acta Neurol Scand. 2000;101(5):327–31. DOI: https://doi.org/10.1034/j.1600-0404.2000.90342a.x
Brown MM. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): A randomised trial. Lancet. 2001;357(9270):1729–37. DOI: https://doi.org/10.1016/S0140-6736(00)04893-5
Rumack C M , Wilson S R CJW. Diagnostic Ultrasound. Second Edi. New York; 1998. 885–916 p.
Droste, D.W., et al., Four-gated transcranial Doppler ultrasound in the detection of circulating microemboli. European journal of ultrasound, 1999. 9(2): p. 117-125. DOI: https://doi.org/10.1016/S0929-8266(99)00021-X
Ritter MA, Dittrich R, Thoenissen N, Ringelstein EB, Nabavi DG. Prevalence and prognostic impact of microembolic signals in arterial sources of embolism: A systematic review of the literature. J Neurol. 2008;255(7):953–61. DOI: https://doi.org/10.1007/s00415-008-0638-8
Zuromskis T, Wetterholm R, Lindqvist JF, Svedlund S, Sixt C, Jatuzis D, et al. Prevalence of Micro-Emboli in Symptomatic High Grade Carotid Artery Disease: A Transcranial Doppler Study. Eur J Vasc Endovasc Surg. 2008;35(5):534–40. DOI: https://doi.org/10.1016/j.ejvs.2008.01.001
Topakian R, King A, Kwon SU, Schaafsma A, Shipley M, Markus HS. Ultrasonic plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis. Neurology. 2011;77(8):751–8. DOI: https://doi.org/10.1212/WNL.0b013e31822b00a6
Safouris A, Katsanos AH, Kerasnoudis A, Krogias C, Kinsella JA, Sztajzel R, et al. Statin pretreatment and microembolic signals in large artery atherosclerosis a systematic review and meta-analysis. Stroke. 2018;49(8):1992–5. DOI: https://doi.org/10.1161/STROKEAHA.118.021542
David Spence J, Coates V, Li H, Tamayo A, Muñoz C, Hackam DG, et al. Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis. Arch Neurol. 2010;67(2):180–6. DOI: https://doi.org/10.1001/archneurol.2009.289
Mitchell CC, Wilbrand SM, Kundu B, Steffel CN, Varghese T, Meshram NH, et al. Transcranial Doppler and Microemboli Detection: Relationships to Symptomatic Status and Histopathology Findings. Ultrasound Med Biol. 2017;43(9):1861–7. DOI: https://doi.org/10.1016/j.ultrasmedbio.2017.04.025