Asymptomatic Cerebral Embolic Signals in Patients With Carotid Stenosis

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Abstract
Background and Purpose Asymptomatic cerebral emboli may be detected in patients with carotid stenosis by transcranial Doppler ultrasonography of the middle cerebral artery (MCA). The aim of this study was to determine the angiographic correlates of such embolic signals. Methods Doppler signals from 48 MCAs in 26 patients with carotid stenosis that was either symptomatic (n=20) or asymptomatic (n=6) were recorded for 40 minutes. The grade of carotid stenosis and the ulcerated or nonulcerated appearance of the plaque were assessed using the criteria of the North American Symptomatic Carotid Endarterectomy Trial. Results Embolic signals were detected in 8 MCAs from 7 patients; 4 (50%) of these MCAs were clinically symptomatic compared with 16 (40%) without embolic signal. Although there was a trend toward more severe stenosis in the cases with embolic signals, this was not significant (mean±SD, 67±29% versus 55±36%). In contrast, an image of ulceration was found on ipsilateral carotid angiography in 5 cases (63%) with embolic signals and in only 9 cases (23%) without embolic signals (odds ratio, 5.74; 95% confidence interval, 1.15 to 28.79, by multivariate regression analysis). Conclusions This study demonstrates that the occurrence of embolic signals in patients with carotid stenosis is associated with the appearance of plaque ulceration on angiography.