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. 2024 Mar;26(1):23-29.
doi: 10.7461/jcen.2023.E2023.05.002. Epub 2023 Oct 10.

Transcranial Doppler emboli monitoring for stroke prevention after flow diverting stents

Matias Costa  1 , Paul Schmitt  2 , Jaleel N  1   3 , Matias Baldoncini  4 , Juan Vivanco-Suarez  1 , Bipin Chaurasia  5 , Colleen Douville  1 , Loh Yince  1 , Akshal Patel  1 , Stephen Monteith  1
Affiliations

Transcranial Doppler emboli monitoring for stroke prevention after flow diverting stents

Matias Costa et al. J Cerebrovasc Endovasc Neurosurg. 2024 Mar.

Abstract

Objective: Flow diverting stents (FDS) are increasingly used for the treatment of intracranial aneurysms. While FDS can provide flow diversion of parent vessels, their high metal surface coverage can cause thromboembolism. Transcranial Doppler (TCD) emboli monitoring can be used to identify subclinical embolic phenomena after neurovascular procedures. Limited data exists regarding the use of TCDs for emboli monitoring in the periprocedural period after FDS placement. We evaluated the rate of positive TCDs microembolic signals and stroke after FDS deployment at our institution.

Methods: We retrospectively evaluated 105 patients who underwent FDS treatment between 2012 and 2016 using the Pipeline stent (Medtronic, Minneapolis, MN, USA). Patients were pretreated with aspirin and clopidogrel. All patients were therapeutic on clopidogrel pre-operatively. TCD emboli monitoring was performed immediately after the procedure. Microembolic signals (mES) were classified as "positive" (<15 mES/hour) and "strongly positive" (>15 mES/hour). Clinical stroke rates were determined at 2-week and 6-month post-operatively.

Results: A total of 132 intracranial aneurysms were treated in 105 patients. TCD emboli monitoring was "positive" in 11.4% (n=12) post-operatively and "strongly positive" in 4.8% (n=5). These positive cases were treated with heparin drips or modification of the antiplatelet regimen, and TCDs were repeated. Following medical management modifications, normalization of mES was achieved in 92% of cases. The overall stroke rates at 2-week and 6-months were 3.8% and 4.8%, respectively.

Conclusions: TCD emboli monitoring may help early in the identification of thromboembolic events after flow diversion stenting. This allows for modification of medical therapy and, potentially, preventionf of escalation into post-operative strokes.

Keywords: Endovascular stent; Flow diverter; Intracranial aneurysm; Transcranial Doppler Ultrasonography.

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Conflict of interest statement

Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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