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We know that subclinical cerebral embolization (detected by transcranial Doppler ultrasound or diffusion-weighted magnetic resonance imaging [MRI]) occurs during carotid artery revascularization — more so with stenting than with endarterectomy. Two studies shed additional light on this complication.
In a University of Texas study, 40 patients with carotid stenosis underwent stenting; stenoses were symptomatic (i.e., associated with previous stroke or transient ischemic attack [TIA]) in 17 patients and asymptomatic in 23. On transcranial Doppler, microembolic counts during procedures were similar in symptomatic and asymptomatic patients (median, about 300). Diffusion-weighted MRI, done immediately before and 24 hours after stenting, demonstra…