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NEUROLOGY 1994;44:615
© 1994 American Academy of Neurology

Cerebral microembolism in symptomatic and asymptomatic high-grade internal carotid artery stenosis

M. Siebler, MD, A. Kleinschmidt, MD, M. Sitzer, MD, H. Steinmetz, MD and H.-J. Freund, MD

Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany.

Using transcranial Doppler (TCD) ultrasonography in patients with high-grade (>=70%) internal carotid artery (ICA) stenosis, we examined the relation between the rate of TCD-detected silent microembolism of the ipsilateral middle cerebral artery and a history of recent (<121 days) ischemic symptoms attributable to the diseased ICA. In the so-defined neurologically symptomatic group (n = 33 patients), silent microembolic events occurred in 27 subjects (overall mean rate, 14/h ± 29). Among 56 neurologically asymptomatic patients matched for the degree of ICA stenosis, only nine showed such events (overall mean rate, 0.35/h ± 1.4). Across all 89 patients studied, an individual microembolic event rate ≥2/h had a positive predictive value of 0.88 for a history of recent symptoms. Our data suggest that TCD monitoring can provide reliable paraclinical evidence of "unstable ICA disease."

Supported by grants from the Deutsche Forschungsgemeinschaft (Si 370/4-1).

Received August 9, 1993. Accepted for publication in final form October 5, 1993.

Address correspondence and reprint requests to Dr. Mario Siebler, Department of Neurology, Heinrich-Heine-University, P.O. Box 101007, D-40001 Düsseldorf, Germany.




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