Disappearance of microembolic signals on transcranial doppler after carotid artery stenting: A case report

Abstract

Objective: Microembolic signals (MES) are a predictor of future stroke in patients with carotid artery stenosis. We report a case of carotid artery stenosis in which transcranial Doppler (TCD) showed disappearance of MES after carotid artery stenting (CAS).
Case presentation: A 65-year-old man presented with transient left hemiparesis and homonymous left hemianopsia. Diffusion-weighted magnetic resonance (MR) imaging showed new infarction in the territory of the left middle cerebral artery, and MR angiography showed moderate stenosis in the left cervical internal carotid artery. Although dual antiplatelet treatment was administered, diffusion-weighted MR imaging showed increased infarction, and TCD detected 5 MES in 30 minutes. We decided to perform CAS to prevent artery-to-artery embolism, which was recurrent despite optimal medical treatment. CAS was performed with a Carotid Wallstent 19 days after the onset. TCD obtained 5 days after CAS detected no MES, and no new infarcts were detected as of 1 year after CAS.
Conclusion: CAS using the Carotid Wallstent can prevent medication-resistant embolic stroke due to carotid artery stenosis, and TCD is useful to evaluate the effect of the treatment.