Prediction of early cerebral outcome by transcranial Doppler monitoring in carotid bifurcation angioplasty and stenting

In CAS, in addition to such obviously adverse events as particulate macroembolism and massive air embolism, multiple microemboli (>5 showers) at postdilation after stent deployment and angioplasty-induced asystole and hypotension with a significant reduction of middle cerebral artery blood flow velocities are associated with periprocedural cerebral deficits. In combination with the presence of preprocedural cerebral symptoms, these four TCD monitoring variables reasonably differentiate between patients with and without adverse cerebral outcome. TCD monitoring provides insight into the pathogenesis of CAS related adverse cerebral events.