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Assessment of cerebral embolism and vascular reserve parameters in patients with carotid artery stenosis
- Department of Neurology, Medical University of Silesia, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
- Department of General and Vascular Surgery, Medical University of Silesia, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
open access
Abstract
Carotid artery stenosis can result in the brain tissue injury related to the intracranial aterial flow disturbances as well as microembolic complications. The choice of the proper therapy in patients with carotid artery stenosis, especially asymptomatic, remains still a significant clinical problem. The study aim was an assessment of the cerebral embolism and brain vascular reserve parameters in patients with carotid artery stenosis regarding the occurrence of the clinical symptoms, the degree of stenosis as well as plaque morphology.
MethodsThe study included 60 patients, with internal carotid artery stenosis. The degree of stenosis, the atherosclerotic plaque surface and morphology were assessed by the means of Duplex Doppler ultrasound. Cerebrovascular reactivity (vasomotor reactivity reserve test and Breath Holding Index) and monitoring of the microembolic signals (MES) were assessed with transcranial Doppler ultrasound examination (TCD).
ResultsThe vasoreactivity parameters were significantly lower in the group of patients with stenosis ≥70% and in patients with ulcerations on the plaque surface. Microembolic signals were recorded significantly more often in symptomatic patients; in patients with stenosis ≥70%; in patients with ulcerations on the plaque surface and those with hypoechogenic plaque structure.
ConclusionsMicroembolic signals in patients with symptomatic carotid stenosis are one of the ultrasound features of unstable carotid stenosis. Worse reactivity parameters of the cerebral arteries are associated with the presence of a large degree of carotid artery stenosis.
Abstract
Carotid artery stenosis can result in the brain tissue injury related to the intracranial aterial flow disturbances as well as microembolic complications. The choice of the proper therapy in patients with carotid artery stenosis, especially asymptomatic, remains still a significant clinical problem. The study aim was an assessment of the cerebral embolism and brain vascular reserve parameters in patients with carotid artery stenosis regarding the occurrence of the clinical symptoms, the degree of stenosis as well as plaque morphology.
MethodsThe study included 60 patients, with internal carotid artery stenosis. The degree of stenosis, the atherosclerotic plaque surface and morphology were assessed by the means of Duplex Doppler ultrasound. Cerebrovascular reactivity (vasomotor reactivity reserve test and Breath Holding Index) and monitoring of the microembolic signals (MES) were assessed with transcranial Doppler ultrasound examination (TCD).
ResultsThe vasoreactivity parameters were significantly lower in the group of patients with stenosis ≥70% and in patients with ulcerations on the plaque surface. Microembolic signals were recorded significantly more often in symptomatic patients; in patients with stenosis ≥70%; in patients with ulcerations on the plaque surface and those with hypoechogenic plaque structure.
ConclusionsMicroembolic signals in patients with symptomatic carotid stenosis are one of the ultrasound features of unstable carotid stenosis. Worse reactivity parameters of the cerebral arteries are associated with the presence of a large degree of carotid artery stenosis.
Keywords
Carotid stenosis, Transcranial Doppler, Cerebrovascular reactivity, Vasomotor reactivity test, Microembolic signal
Title
Assessment of cerebral embolism and vascular reserve parameters in patients with carotid artery stenosis
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
356-362
Page views
334
Article views/downloads
598
DOI
10.1016/j.pjnns.2016.06.004
Bibliographic record
Neurol Neurochir Pol 2016;50(5):356-362.
Keywords
Carotid stenosis
Transcranial Doppler
Cerebrovascular reactivity
Vasomotor reactivity test
Microembolic signal
Authors
Przemyslaw Puz
Anetta Lasek-Bal
Tomasz Urbanek
Zofia Kazibutowska