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22. European Stroke Conference 396 © 2013 S. Karger AG, Basel Scientific Programme 212 Vascular imaging Strokes and TIAs during and after carotid artery Doppler: Cause or coincidence? V. Papavasileiou1, H. Milionis2, L. Hirt3, P. Michel4 Department of Medicine, Larissa Medical School, University of Thessaly, Greece, Larisa, GREECE1, Department of Internal Medicine, School of Medicine, University of Ioannina, Greece, Ioannina, GREECE2, Stroke Unit, Neurology Service, Department of Neurosciences, Centre Hos-pitalier Universitaire Vaudois, Switzerland, Lausanne, SWITZERLAND3, Stroke Unit, Neurology Service, Department of Neurosciences, Centre Hospitalier Universitaire Vaudois, Switzerland, Laus-anne, SWITZERLAND4 Background: Ultrasound imaging is widely used in the etiologic work-up of strokes and transient ischemic attacks. The aim of the present study was to explore the prevalence of acute cerebrovas-cular symptoms temporally related to carotid Doppler examination (Dex) and to discuss possible mechanisms. Methods: We collected consecutive patients with acute onset neurological symptoms during or shortly after carotid DEx in the University Hospital of Lausanne over 9 years. Results: Four patients among approximately 27,000 examined internal carotids were identified (in-cidence of 0.015%). Three of them had cerebrovascular symptoms during the last 14 days and the fourth one was on a scheduled annual follow-up visit of a 40-50% left internal carotid artery steno-sis. None of the patients was symptomatic when the DEx started. Neurological symptoms presented acutely during the DEx or 5-10 minutes after the carotid arteries were examined. All four patients had atherosclerotic plaques with features of instability, including one with a floating thrombus and another with a reversible carotid occlusion. In two patients, arterial imaging findings between the DEx and the ensuing arterial imaging changed, and two patients were treated with acute thromboly-sis. On 3-month follow-up, the thormbolyzed patients had a modified Rankin Scale of 2 whereas the other two patients’ score 0. Hypothetical mechanisms include a chance relationship, plaque throm-bus mobilisation from mechanical manipulation or ultrasonographic effects, and hemodynamic stroke from extrinsic compression or carotid sinus stimulation. Conclusions: Overwhelming advantages of carotid Doppler imaging are not challenged by rare isch-emic cerebrovascular events during or immediately after the examination.


Karger_ESC London_2013
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