Microembolisation After Carotid Revascularisation
Microembolisation After Carotid Revascularisation
Microembolisation identified on diffusion-weighted magnetic resonance imaging (DW-MRI) is
 recognized as an important outcome measure for carotid revascularization procedures such as
 carotid stenting (CAS) or carotid endarterectomy (CEA). In fact, cerebral microembolisation
 occurring during revascularization procedures is associated with an increased risk of peri-
 and post-procedural stroke, transient ischemic attack as well as neurocognitive decline.
 Carotid artery stenting is a less invasive alternative to endarterectomy to treat symptomatic
 or asymptomatic carotid stenosis. Large randomized clinical trials showed a higher
 periprocedural risk of non-disabling stroke with CAS and a higher periprocedural risk of
 myocardial infarction, cranial nerve palsy, and access site hematoma with CEA.

 However little is known regarding the correlation between the morphological characteristics
 of the carotid plaque and the occurrence of microembolisation during the procedure and
 between microembolisation and midterm cognitive impairment. A few studies suggest that plaque
 morphology may be an important determinant for the increased risk of microembolisation. These
 studies however have mainly investigated microembolisation occurring during CAS and
 exploratory studies comparing the two procedures are still lacking.

 The purpose of the present study is to determine the correlation between the morphological
 characteristics of the carotid plaque and cerebral microembolisation either after carotid
 stenting or after carotid endarterectomy in patients with symptomatic or asymptomatic carotid
 disease.
Inclusion Criteria:

 -  Patients presenting a symptomatic (ipsilateral ischemic stroke, TIA located in the
 carotid artery territory or retinal ischemia) carotid stenosis between 50% and 99%
 (according to NASCET and ECST criteria)

 -  Patients presenting an asymptomatic carotid stenosis between 60% and 99% (according to
 NASCET and ECST criteria) Patients who accept the informed consent

 Exclusion Criteria:

 -  Important neurological deficit with NIHSS >7 (or severe aphasia) at time of inclusion

 -  Previous known cognitive impairment

 -  Pregnancy

 -  Presence of contraindication based on ground of multidisciplinary team decision:

 -  For surgery:

 High bifurcation Intracranial extension of the carotid stenosis Patients with tandem
 lesions High suspicion of severe siphon stenosis Patients with previous irradiation of the
 cervical region Patients with restenosis after endarterectomy

 -  For stenting; Excessive arch vessel or carotid artery tortuosity and in particular
 presence tortuosity ≤90 degrees in the cervical segment Excessive aortic arch plaque
 burden Patients older than 70 years Unfavourable anatomic disposition as described
 above Co-morbidities that may preclude the use of a periprocedural dual antiplatelet
 regime.

 -  For CT-scan Iodine allergy Renal insufficiency

 -  For MRI Pacemaker Any other metallic implants Claustrophobia

 -  For ultrasound Bad quality ultrasound (patient morphology or equipments