O-214 - TRANSCRANIAL DOPPLER, ULTRASOUND CHARACTERISTICS AND PLAQUE'S HISTOLOGY OF ASYMPTOMATIC CAROTID STENOSIS UNDERGOING SURGICAL REPAIR IN A PROSPECTIVE OBSERVATIONAL COHORT: THE EMBOLIC SIGNALS DETECTION TRIAL (ESDT).

TOPIC:
Other
AUTHORS:
Pizzarelli G. (Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia ~ Modena ~ Italy) , Gennai S. (Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia ~ Modena ~ Italy) , Leone N. (Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia ~ Modena ~ Italy) , Covic T. (Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia ~ Modena ~ Italy) , Moratto R. (Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia ~ Modena ~ Italy) , Silingardi R. (Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia ~ Modena ~ Italy)
Introduction:
Whether surgery is beneficial for patients with asymptomatic carotid stenosis is controversial. We firstly aimed to evaluate the embolic risk in asymptomatic carotid stenosis (≥70%) patients by use of transcranial doppler (TCD) to detect and count micro-embolic signals (MES). Secondarily, to assess the MES relationship with the stenosis severity, histopathological and ultrasound characteristics of carotid plaques. The Embolic Signals Detection Trial (ESDT) was a single-center, prospective, observational cohort.
Methods:
Consecutive patients already scheduled for CEA were enrolled. Computed tomography angiography and ultrasound assessment (Geroulakos classification) were mandatory. MES number and characteristics were investigated in Holter mode with transcranial doppler (TCD-X) device with standard 1.5 MHz probe. The time-points of evaluation were: 24 hours before CEA, 24 hours and 30 days after CEA. The histopathological analysis was performed according to the modified American Heart Association classification. One-way analysis of variance tested MES differences over time. Univariable and multivariable logistic regression assessed histopathological characteristics, ultrasonographic features, and the stenosis severity with MES.
Results:
A total of 120 patients demonstrated a significant reduction of the mean number of MES (3.35±10.04 and 0.82±2.39; pre- and post-CEA respectively), becoming undetectable at 30 days (p=.001). Ultrasound classification was associated with MES occurrence with hypoechogenic plaques being risk factors (p=.001). Vulnerability plaque's features, such as hemorrhagic component (p=.011), neovascularization (p=.025), signs of inflammation (p=.027), and rupture of the fibrous cap (p=.002) were MES' predictors. Cap rupture was the only predictor at the multivariate analysis (OR=5.98; p=.030). The stenosis severity was not associated with MES (p= .95)
Conclusion:
The embolic activity was no more detectable after surgery. Both ultrasound and histologic markers of vulnerability were predictors of MES. TCD gives better insight into the real embolic risk, and future studies should evaluate its implementation with standard imaging techniques. Clinical results coming on counting MES or not and stenosis severity as the only parameter of surgical decision-making require further research.