Evidence map›Paper›PMID 28077455›Full record

Observational studyStroke2017

Symptomatic Carotid Occlusion Is Frequently Associated With Microembolization.

Ava L Liberman, Ali Zandieh, Caitlin Loomis, Jonathan M Raser-Schramm, Christina A Wilson, Jose Torres, Koto Ishida, Swaroop Pawar, Rebecca Davis, Michael T Mullen and 3 more

Open access · bronzeAbstract readObservational Study

PubMed Full text at PMC Publisher

In one paragraph

Observational study in Stroke, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it

0cells of the map it votes in

10citing papers in PubMed

2.9field-weighted citation impact, top 9% of its field

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 33 citations in OpenAlex.

Occlusion site and outcomes in intra-arterial tenecteplase after successful endovascular therapy: a secondary analysis of the ANGEL-TNK trial.Journal of neurointerventional surgery · 2026
Trial
Microemboli After Successful Thrombectomy Do Not Affect Outcome but Predict New Embolic Events.Stroke · 2020
Trial
Suspected ophthalmic artery fat embolus following bilateral elbow liposuction.American journal of ophthalmology case reports · 2026
Article
In situ protein corona-camouflaged supramolecular assemblies remodel thrombotic microenvironment for improved arterial homeostasis.Science advances · 2025
Article
Diagnosis and treatment of Watershed strokes: a narrative review.Journal of medicine and life · 2023
Review
Carotid Stump Syndrome With Stent-Assisted Coil Embolization.Cureus · 2022
Article
White matter hyperintensity determines ischemic stroke severity in symptomatic carotid artery stenosis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2021
Article
A narrative review of the pathophysiology of ischemic stroke in carotid plaques: a distinction versus a compromise between hemodynamic and embolic mechanism.Annals of translational medicine · 2021
Review
Mapping Cerebrovascular Reactivity Impairment in Patients With Symptomatic Unilateral Carotid Artery Disease.Journal of the American Heart Association · 2021
Observational
Does Left Atrial Appendage Closure Reduce Mortality? A Vital Status Analysis of the Randomized PROTECT AF and PREVAIL Clinical Trials.Journal of atrial fibrillation · 2018
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 5 institutions in 1 country.

Ava L LibermanFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.). avliberm@montefiore.org.

Ali ZandiehFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Caitlin LoomisFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Jonathan M Raser-SchrammFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Christina A WilsonFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Jose TorresFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Koto IshidaFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Swaroop PawarFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Rebecca DavisFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Michael T MullenFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Steven R MesséFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Scott E KasnerFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Brett L CucchiaraFrom the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (A.L.L.); Department of Neurology, University of Illinois, Chicago (A.Z.); Department of Neurology, Yale Medical School, New Haven, CT (C.L.); Department of Neurology, Christiana Care Health System, Wilmington, DE (J.M.R.-S.); Department of Neurology, University of Florida, Gainesville (C.A.W.); Department of Neurology, New York University Langone Medical Center (J.T., K.I.); Department of Neurology, Abington Memorial Hospital, PA (S.P.); Department of Internal Medicine (R.D.), Department of Neurology (M.T.M., S.R.M., S.E.K., B.L.C.), and Leonard Davis Institute, University of Pennsylvania, Philadelphia (M.T.M.).

Abington Memorial Hospital · USUniversity of Illinois Chicago · USYale University · USUniversity of Florida · USAlbert Einstein College of Medicine · US

Funding

The Philadelphia Regional Stroke Trials Network Coordinating Center (PRSTNCC)U24NS107224 · NINDS · UNIVERSITY OF PENNSYLVANIA · PI Brett Lee Cucchiara · 2018 to 2026

$3.2M

The Philadelphia Regional Stroke Trials Network coordinating Center (PRSTNCC)U10NS086474 · NINDS · UNIVERSITY OF PENNSYLVANIA · PI KASNER, SCOTT E · 2013 to 2017

$1.9M

NINDS NIH HHS U10 NS086474NINDS NIH HHS U24 NS107224

6 · The paper itself

Abstract

background and purposeSymptomatic carotid artery disease is associated with significant morbidity and mortality. The pathophysiologic mechanisms of cerebral ischemia among patients with carotid occlusion remain underexplored.

methodsWe conducted a prospective observational cohort study of patients hospitalized within 7 days of ischemic stroke or transient ischemic attack because of ≥50% carotid artery stenosis or occlusion. Transcranial Doppler emboli detection was performed in the middle cerebral artery ipsilateral to the symptomatic carotid. We describe the prevalence of microembolic signals (MES), characterize infarct topography, and report clinical outcomes at 90 days.

resultsForty-seven patients, 19 with carotid occlusion and 28 with carotid stenosis, had complete transcranial Doppler recordings and were included in the final analysis. MES were present in 38%. There was no difference in MES between those with carotid occlusion (7/19, 37%) compared with stenosis (11/28, 39%; P=0.87). In patients with radiographic evidence of infarction (n=39), 38% had a watershed pattern of infarction, 41% had a nonwatershed pattern, and 21% had a combination. MES were present in 40% of patients with a watershed pattern of infarction. Recurrent cerebral ischemia occurred in 9 patients (19%; 6 with transient ischemic attack, 3 with ischemic stroke). There was no difference in the rate of recurrence in those with compared to those without MES.

conclusionsCerebral embolization plays an important role in the pathophysiology of ischemia in both carotid occlusion and stenosis, even among patients with watershed infarcts. The role of aggressive antithrombotic and antiplatelet therapy for symptomatic carotid occlusions may warrant further investigation given our findings.

Indexed as

Embolization, TherapeuticAgedBrain IschemiaCarotid StenosisCohort StudiesFemaleFollow-Up StudiesHumansMaleMiddle AgedProspective StudiesSingle-Blind Methodcarotid artery diseasescarotid stenosiscerebral ischemiaembolismultrasonography, doppler, transcranial

Identifiers

PMID28077455

DOI10.1161/STROKEAHA.116.015375

PMCPMC5821136

OpenAlexW2573775555

What OpenQuestion holds

Textmetadata

LicenceTDM

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.