![]() The hazard ratio for ipsilateral stroke alone was 5.57. The hazard ratio for stroke or TIA was 2.54 as compared with patients without embolic signals at baseline. The study included 267 patients embolic signals were present in 77 patients at baseline. ![]() The primary endpoint was ipsilateral stroke or TIA. 112 This was a prospective observational study including patients with carotid stenosis of at least 70% who were followed for at least 2 years. The Asymptomatic Carotid Emboli Study (ACES) attempted to investigate whether detection of embolic signals by use of TCD could predict stroke risk in patients with asymptomatic carotid stenosis. 113 Thus the concept of HITS represents an attractive option for stratifying patients with carotid artery disease who may be at increased risk for future stroke. 113 HITS frequency rises with increasing stenosis, and an increased rate of HITS is associated with plaque ulceration this emphasizes the likely association between HITS and plaque instability. HITS are detectable only in the presence of an embolic source, are undetectable days after CEA, and are absent in controls without carotid stenosis, suggesting a relationship between carotid atherosclerotic plaque and microembolization. 113 Transcranial Doppler (TCD) testing involves the detection of microembolism in the MCA using TCD insonation the detection of high-intensity transient signals (“HITS”) is felt to represent microemboli to the brain. Since thromboembolization is generally regarded as the mechanism of ischemic stroke in patients with carotid bifurcation atherosclerosis, the detection of subclinical embolization may help to identify patients at high risk of future stroke. Sidawy MD, MPH, in Rutherford's Vascular Surgery and Endovascular Therapy, 2019 Transcranial Doppler Detection of Microembolization
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