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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
CAROTID CONSENSUS UPDATE
Italian Journal of Vascular and Endovascular Surgery 2011 June;18(2):87-93
Value of transcranial Doppler monitoring in asymptomatic patients. A systematic review and meta-analysis
Salem M K., Sayers R. D., Bown M. J., Naylor A. R.
˝Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
Unstable carotid atherosclerotic plaque leading to stroke is a major cause of morbidity and mortality in the western world. Transcranial Doppler (TCD) monitoring to detect spontaneous embolisation in the middle cerebral artery in symptomatic patients is an independent risk factor for recurrent cerebral ischaemic events. Identifying high risk asymptomatic patients with unstable carotid plaques can assist clinicians in tailoring patient specific management. The use of TCD monitoring to detect spontaneous embolisation in asymptomatic patients has been considered as an effective tool to identify high risk patients. This paper will review the current evidence for TCD monitoring in asymptomatic patients. A systematic review was performed using Embase, Medline and Pubmed databases. Prospective cohort studies that were found to match the selection criteria were included in the review and meta-analysis performed. The systematic review identified eight published series. A meta-analysis of the eight published series involving 1674 patients showed a hazards ratio for the risk of ipsilateral stroke for those with spontaneous embolisation on TCD monitoring compared to those without was 8.58 (95% CI 4.77-15.44); P<0.0001), with no heterogeneity between studies (P=0.41). The use of TCD monitoring in asymptomatic patients can identify a high risk sub group of patients that would benefit from early intervention.