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.
Dr. Tedesco and her colleagues at Stanford (Calif.) University had previously shown a greater risk of microemboli with carotid angioplasty and stenting (CAS) than with carotid endarterectomy (CEA).
That link emerged again in her retrospective study of 64 consecutive carotid patients. Based on 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 of the patients with microemboli had no neurologic symptoms. In those who did experience symptoms, most resolved within 36 hours. No patient 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 risk factors for the development of microemboli. The only significant association was the presence of CAD. There was no link 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, peripheral vascular disease, or atrial fibrillation. Nor was there any association between microemboli and total fluoroscopy time or the performance of an arch angiogram.
Since 80% of the patients who had new microemboli after intervention had a history of CAD, Dr. Tedesco said, “This finding should be considered when recommending CAS for patients who are deemed high risk due solely to cardiac comorbidity.”