Differences in number, size and location of intracranial microembolic lesions after surgical versus endovascular treatment without protection device of carotid artery stenosis

Background and purpose: The benefit of carotid endarterectomy in symptomatic high-grade stenosis has long been proven. The role of angioplasty as an alternative is still a matter of debate. We compared the occurrence of intraprocedural microembolic signals and ischemic lesions between carotid endarterectomy (CEA) and carotid angioplasty with stent placement (CAS) without a protection device. Methods: 88 patients who underwent a CEA and 41 patients who underwent CAS were prospectively investigated. One day before and after the intervention diffusion weighted MRI-studies were obtained. In 21 CEA and 18 CAS patients transcranial Doppler (TCD) monitoring was performed during the procedure to detect microembolic signals (MES). Results: DWI-lesions could be detected after intervention in 17 % of the CEA patients compared with 54 % of the CAS patients (p < 0.005). The median lesion volume was 0.08 cm ³ in the CEA group and 0.02 cm³ in the CAS group (p < 0.001). Ischemic complications consisted of 2 strokes (2.3 %) with symptoms lasting more than seven days in the CEA group and 1 stroke (2.4 %) in the CAS group. The median number of MES in the CEA group was 17 versus 61 in the CAS group (p < 0.001). No significant correlation was found between the total number of MES and ischemic lesions in either group. Conclusion: A larger number of emboligenic particles with smaller volume is detached during CAS. Additionally DWI lesions were observed in different territories after CAS but not after CEA. Conventional TCD emboli detection is not useful to compare interventional therapies of the carotid arteries.