Transcranial Doppler emboli monitoring for stroke prevention after flow diverting stents.

Publication Title

J Cerebrovasc Endovasc Neurosurg

Authors

Matias Costa, Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, USA.Follow
Paul Schmitt
Jaleel N, Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, USA.
Matias Baldoncini
Juan Vivanco-Suarez, Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, USA.
Colleen Douville, Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, USA.Follow
Yince Loh, Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, USA.Follow
Akshal Patel, Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, USA.Follow
Stephen Monteith, Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, USA.Follow
Bipin Chaurasia

Document Type

Article

Publication Date

10-10-2023

Keywords

Endovascular stent; Flow diverter; Intracranial aneurysm; Transcranial Doppler; washington; swedish neuro

Abstract

OBJECTIVE: Flow diverting stents (FDS) are increasingly used for the treatment of intracranial aneurysms. While FDS can provide flow diversion of parent vessels, their high metal surface coverage can cause thromboembolism. Transcranial Doppler (TCD) emboli monitoring can be used to identify subclinical embolic phenomena after neurovascular procedures. Limited data exists regarding the use of TCDs for emboli monitoring in the periprocedural period after FDS placement. We evaluated the rate of positive TCDs microembolic signals and stroke after FDS deployment at our institution.

METHODS: We retrospectively evaluated 105 patients who underwent FDS treatment between 2012 and 2016 using the Pipeline stent (Medtronic, Minneapolis, MN, USA). Patients were pretreated with aspirin and clopidogrel. All patients were therapeutic on clopidogrel pre-operatively. TCD emboli monitoring was performed immediately after the procedure. Microembolic signals (mES) were classified as "positive" (/hour) and "strongly positive" (>15 mES/hour). Clinical stroke rates were determined at 2-week and 6-month post-operatively.

RESULTS: A total of 132 intracranial aneurysms were treated in 105 patients. TCD emboli monitoring was "positive" in 11.4% (n=12) post-operatively and "strongly positive" in 4.8% (n=5). These positive cases were treated with heparin drips or modification of the antiplatelet regimen, and TCDs were repeated. Following medical management modifications, normalization of mES was achieved in 92% of cases. The overall stroke rates at 2-week and 6-months were 3.8% and 4.8%, respectively.

CONCLUSIONS: TCD emboli monitoring may help early in the identification of thromboembolic events after flow diversion stenting. This allows for modification of medical therapy and, potentially, preventionf of escalation into post-operative strokes.

Clinical Institute

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences

Specialty/Research Institute

Surgery

DOI

10.7461/jcen.2023.E2023.05.002