Osman Mir, MD

Almekhalfi et al. explore the relationship between carotid artery angioplasty and stenting (CAS) and periprocedural stroke in a prospective single arm observational study in a single center cohort. They examined with TCD 30 patients undergoing CAS, and counted the number of microembolic signals (MIS) according to the stage in the procedure when they occurred   

Surprisingly, they did not find any correlation between the number of emboli detected and the number of DWI lesions on the post-procedure MRI. Most patients had DWI lesions, but these were mostly asymptomatic, and the number of lesions was not associated with the symptomatic state of the patients. The fascinating thing is they found the largest number of emboli when a device, such as a stent or protection device, was deployed. 

Given that this is a small single arm, single center non randomized study the novel aspect is which part of the CAS procedure carries the largest risk of embolization. Maybe the deployment stage of the procedure can be modified to make sure that this embolization risk is minimized?