Incidence and predictors of calcified cerebral emboli detected in patients who underwent endovascular procedures

Objectives: There are very few reports on calcified cerebral emboli associated with endovascular procedures. We aimed to evaluate the incidence rates and predictors of calcified cerebral emboli in patients who underwent carotid artery stenting (CAS)/percutaneous transluminal angioplasty (PTA). Patients and methods: Patient demographics, clinical characteristics, and operative records of patients who underwent CAS/PTA were retrospectively analyzed. A total of 211 consecutive patients with cervical internal carotid stenosis were included in this study. Patients were categorized according to the presence of calcified cerebral emboli in postoperative computed tomography (CT) into emboli and non-emboli groups. We defined calcified emboli as a CT value of 60-400 Hounsfield units. Results: On postoperative non-contrast CT, calcified emboli were detected in 5 of the 211 cases after CAS/PTA. The emboli were located in the middle cerebral artery (2/5), anterior cerebral artery (1/5), posterior cerebral artery (2/5). All of the cases of calcified cerebral emboli were clinically asymptomatic. The characteristics of patients showed no apparent difference in this study. Although the limited number may be attributed to a lack of statistical power, the average baseline activated clotting time (ACT) was lower in the emboli group than in the non-emboli group (117 vs 153, p < 0.05), and the operative time was longer in the emboli group than in the non-emboli group (147 vs 111, p < 0.05). Conclusion: Calcified cerebral emboli may be more common than previously known. Lower average baseline ACT and longer operative time could be predictors of calcified cerebral emboli after endovascular procedures.