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. 2017 Sep;43(9):1861-1867.
doi: 10.1016/j.ultrasmedbio.2017.04.025. Epub 2017 Jun 20.

Transcranial Doppler and Microemboli Detection: Relationships to Symptomatic Status and Histopathology Findings

Carol C Mitchell  1 , Stephanie M Wilbrand  2 , Bornali Kundu  2 , Catherine N Steffel  3 , Tomy Varghese  4 , Nirvedh H Meshram  4 , Geng Li  5 , Thomas D Cook  5 , M Shahriar Salamat  6 , Robert J Dempsey  2
Affiliations

Transcranial Doppler and Microemboli Detection: Relationships to Symptomatic Status and Histopathology Findings

Carol C Mitchell et al. Ultrasound Med Biol. 2017 Sep.

Abstract

The purpose of this study was to determine the relationship between symptomatic status, transcranial Doppler (TCD) microemboli presence and plaque histopathology findings. TCD was performed on 60 patients (37 symptomatic, 23 asymptomatic) before undergoing clinically indicated carotid endarterectomy. The frequency of microemboli signals was not significantly different between symptomatic and asymptomatic subject groups (p = 0.88) and there were no differences observed in the macroscopic or histopathology scoring of these plaques (p-values all > 0.05). The presence of microemboli was associated with an ulceration score (regardless of symptomatic or asymptomatic status, p = 0.034), with a one-level increase in ulceration rating associated with an odds ratio of 5.86 (95% [CI] 1.55, 43.4). These findings suggest that both symptomatic and asymptomatic patients may have plaque with similar features of instability and ability to create emboli. Thus, identifying new ways to measure plaque instability may provide important information for optimizing treatment to prevent future stroke.

Keywords: High intensity transient signals (HITS); Microemboli; Transcranial Doppler; Ultrasound.

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Conflict of interest statement

Conflicts of Interest

S.M. Wilbrand: None.

C.N. Steffel: None.

T. Varghese: No financial benefit.

N. H. Meshram: None.

G. Li: None.

S. Salamat: None.

R.J. Dempsey: None.

Figures

Figure 1
Figure 1
Panel A demonstrates the presence of a high intensity transient signal on TCD examination (yellow arrow and red circle). Panel B demonstrates the change in complex associated with the high intensity transient signal.
Figure 2
Figure 2
Presence of HITS in asymptomatic and symptomatic patients. No significant difference is noted between the two groups (p=0.88).
Figure 3
Figure 3
Presences of HITS are associated with higher ulceration score.
See this image and copyright information in PMC

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