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Use of TCD in Monitoring Patients During Carotid Artery Stenting

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Noninvasive Vascular Diagnosis

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Abstract

Transcranial Doppler (TCD) provides visible and audible real-time feedback during carotid stent procedures as otherwise clinically silent small embolic particles reflect microembolic signals (MESs) during their egress from the extracranial carotid artery lesion through the middle cerebral artery en route to the ipsilateral hemisphere. During the formative years of carotid stenting, TCD was an important tool for many pioneers in the field as high-risk anatomic carotid access and lesion characteristics were being defined. In addition, TCD helped us understand the flow dynamics related to distal and proximal occlusive embolic protection platforms. Also, the disturbing storm of microembolic signals (MESs) at different stages during distal filter protection led to optimization of these system designs and procedural technique. One cannot argue the contribution TCD made to the art and science of carotid stenting through amplifying the embolization signal from the devastating clinical event of stroke seen in less than 10% of patients to the silent smaller microembolic signals ubiquitous to every procedure. While the MES data seems to have more of an academic value, the contemporary CAS program should have access to TCD and consider following peri-procedural MCA flow patterns during stenting with proximal flow reversal or flow arrest protection systems. In addition, TCD provides significant insight into the physiology of reperfusion syndrome, and changes in MCA flow velocities in patients at high risk for reperfusion syndrome in the early postprocedure time period may be helpful. The objective of this monograph is to expose the reader to some of the lessons learned from adjuvant transcranial Doppler during carotid stent-supported angioplasty while also providing insight into current clinically relevant applications.

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Authors and Affiliations

  1. Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston Area Medical Center, Charleston, WV, USA

    Mark C. Bates M.D., FACC, FSCAI

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  1. Mark C. Bates M.D., FACC, FSCAI
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Correspondence to Mark C. Bates M.D., FACC, FSCAI .

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  1. Robert C. Byrd Health Sciences Center, Dept. Surgery, West Virginia University, MacCorkle Ave. SE 3100, Charleston, 25304, West Virginia, USA

    Ali F. AbuRahma

  2. , Interventional Cardiology, UC San Diego Sulpizio Cardiovascular Cen, 9300 Campus Point Drive 7784, La Jolla, 92037, California, USA

    Dennis F. Bandyk

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Bates, M.C. (2013). Use of TCD in Monitoring Patients During Carotid Artery Stenting. In: AbuRahma, A., Bandyk, D. (eds) Noninvasive Vascular Diagnosis. Springer, London. https://doi.org/10.1007/978-1-4471-4005-4_14

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