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Platelet microemboli have been implicated in the aetiology of transient ischaemic attacks and strokes. Current non-invasive diagnostic methods are restricted to assessing blood flow. Arteriography may demonstrate non-occluding atheromatous ulcers but carries a significant morbidity.111-In labelled platelets and gamma camera imaging of diseased carotid vessels have therefore been evaluated.  Eight patients proceeding to unilateral carotid endarterectomy received an injection of autologous platelets labelled with 111-In-oxine 48 hours preoperatively. Gamma camera images were taken at 4 and 24 hours. Operative endarterectomy specimens were collected and gamma emissions were measured.  The scintigraphic images were independently assessed by two observers. Nine abnormal vessels were identified by platelet accumulation. In 5 cases the observers combined assessment was in complete accord with previous bilateral angiography. Individually each observer identified the symptomatic side in 6 patients. Activity in the endarterectomy specimens measured ex vivo varied from 1.22-84.5 times greater than background activity. The ratio of specimen activity to 5 ml blood samples simultaneously taken varied from 0.017 to 0.360 (mean 0.089).  This non-invasive technique allows localisation of platelet activity in the extracranial cerebral circulation. Objective assessment in vivo is hindered by the relatively small amount of activity on the diseased vessels by comparison with circulating blood activity.

Extracranial Carotid Artery Disease Assessed By Indium-111 Labelled Platelets In Man