Microemboli Post Carotid Tx Linked to CAD

SCOTTSDALE, ARIZ. -- Patients undergoing carotid endarterectomy or carotid angioplasty and stenting are more likely to experience microemboli if they have comorbid coronary artery disease, Dr. Maureen Tedesco said at an international congress on endovascular interventions sponsored by the Arizona Heart Institute.

While earlier studies have shown that carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) are equivalent in most respects, Dr. Tedesco and her colleagues at Stanford (Calif.) University had previously demonstrated a greater risk of microemboli with CAS than with CEA.

That association emerged again in her retrospective study of 64 consecutive carotid patients. Based on a diffusion-weighted MRI images read by two blinded neuroradiologists, 24 (71%) of 34 CAS patients experienced new microemboli compared with 1 (3%) of 30 CEA patients, a significant difference.

Most patients with microemboli experienced no neurologic symptoms whatever. In those who did experience symptoms, most symptoms resolved within 36 hours. None of the patients died or had a stroke within 30 days of the procedure.

Dr. Tedesco looked at a large number of patient and procedural characteristics in a search of significant risk factors for the development of microemboli. The only significant association was the presence of coronary artery disease. There was no association between microemboli and a host of other factors including age, a history of symptomatic disease, stroke, transient ischemic attacks, smoking, diabetes mellitus, hypertension, hyperlipidemia, obesity, chronic obstructive pulmonary disease, peripheral vascular disease, or atrial fibrillation. Nor was there any association between microemboli and total fluoroscopy time or the performance of an arch angiogram. Also, with respect to the patients' anatomic characteristics, there was no significant association between microemboli and lesion ulceration or an unfavorable arch.

Since 80% of the patients who demonstrated new microemboli following carotid intervention had a history of coronary artery disease, Dr. Tedesco suggested that "This finding should be considered when recommending carotid angioplasty and stenting for patients who are deemed high risk due solely to cardiac comorbidity."