Transkranielle farbkodierte Duplexsonographie in der interventionellen Therapie zerebraler Aneurysmen

PURPOSE: To assess the diagnostic potential of transcranial colour-coded duplex sonography in the recognition of residual perfusion of coiled cerebral aneurysms. METHOD: 10 patients (7 female, 3 male) with angiographically verified cerebral aneurysms (basilar artery n = 2, mean size 8.5 mm; supraclinoid internal cerebral artery n = 2, mean size 15.5 mm; posterior communicating artery n = 2, mean size 7 mm; anterior communicating artery n = 2, mean size 4.5 mm) were examined by TCCD using a 2.25 MHz probe immediately following embolisation and 12-24 hours prior to angiographic evaluation. RESULTS: 9 patients had a sufficient temporal bone window. Transtemporal localization of the embolised aneurysms was feasible in 7 of the 9 cases. One partially thrombosed aneurysm of the basilar artery (1 mm) and one completely thrombosed aneurysm of the anterior communicating artery could not be visualised. In 7 cases no discrepancies between TCCD and angiography were evident, since rest, perfusion (n = 6) and complete thrombosis were unanimously diagnosed as such. Mean size of the rest perfused lumina was 4.4 mm (minimum 1.5 mm; maximum 8 mm). Platinum coils appeared as hyperechogenic lesions with an echogenicity comparable to the skull. CONCLUSION: With TCCD residual perfusion of coiled aneurysms was feasible in most cases. The method seems to be specific but not sensitive in the detection of incompletely coiled aneurysms. Limitations are insufficient transtemporal bone windows and inaccessible aneurysm location, especially the anterior communicating artery.