Silent Emboli and Their Relation to Clinical Symptoms in Extracranial Carotid Artery Disease

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Abstract
A history of recent ischemic symptoms is known to define a high-risk subgroup among patients with high-grade extracranial internal carotid artery (ICA) disease. Our data show that at least such a positive history can be predicted with high confidence using transcranial Doppler monitoring for (clinically silent) cerebral microembolism ipsilateral to severe ICA stenosis. Pathoanatomic work in progress suggests that luminal ulcer and thrombosis are major sources of these microemboli. Thus, by studying an important pathomechanism, the detection of silent emboli appears to provide independent, paraclinical evidence of 'unstable ICA disease'.

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