The value of transcranial Doppler before and after percutaneous transtuminl angioplasty and stenting in middle cerebral artery stenosis
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Objective To evaluate the value of transcranial Doppler(TCD) before and after percutaneous transluminal angioplasty and stenting(PTAS) in middle cerebral artery stenosis(MCAS).Methods TCD and digital subtraction angiography(DSA) were performed in 27 cases of patients with MCAS before and after PTAS.Systolic peak flow velocity(Vs),end-diastolic peak flow velocity(Vd),peak flow velocity(Vm),resistance index(RI) and pulsatility index(PI) which detected by TCD were analyzed and compared before and after PTAS.Results There was no significant differences of MCAS diagnosis rates between TCD and DSA(P0.05).Vs,Vd,Vm and PI of the 27 patients were increased after operation whereas RI had no significant change.Conclusions TCD is a non-invasive,cheap and convenience method to be used in preoperative screening,postoperative monitoring and postoperative follow-up review.Keywords:
Transcranial Doppler
Digital subtraction angiography
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Objective To evaluate the effect of transcranial Doppler(TCD) on stent-assisted angioplasty and restenosis of intracarotid artery.Methods Eighty-five patients with cerebral infarction or transient ischemic attack(TIA) were confirmed with severe intracarotid artery stenosis by digital subtraction angiography(DSA).Before stent-assisted angioplasty and after treatment successfully in 3 and 180 days,TCD detected the peaking of systolic velocity(Vs),frequency spectrum and acoustic frequency in middle cerebral artery(MCA),internal carotid artery(ICA1),vertebral artery(VA) and basal artery(BA).Results The diagnosis was coincidence between DSA and TCD before and treatment stent-assisted angioplasty successfully in 85 patients.Three cases developed intracarotid artery restenosis at stent placement detected by TCD,the rate of stenosis within stent 50% by DSA in 6 months.Compared with before stent-assisted angioplasty,the value of Vs was slower in MCA,ICA1,VA and BA of 85 patients which received stent plasty successfully after 3 days(P0.01).The eddy and noise were disappeared,the form of frequency spectrum was improved.It were not significant compared with 180 days after management(P0.05).Conclusion TCD is a sensitive means for clinical to evaluate the effect of intracarotid artery stent-assisted angioplasty,restenosis and a tool of follow-up.
Transcranial Doppler
Digital subtraction angiography
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Objective To explore the value of the diagnosis of middle cerebral artery （MCA） stenosis with transcranial Doppler ultrasound （TCD）. Methods The clinical data in patients with ischemic cerebrovascular disease examined with digital subtract angiography （DSA） and TCD were analyzed retrospectively. DSA was used as a gold standard to analyze the sensitivity and specificity of the diagnosis of MCA stenosis with TCD. The normal and TCD blood flow velocity with different deffees of stenosis were compared. The best cut-off point of the TCD blood flow velocity of MCA at different degree of stenosis was calculated. Results DSA confirmed that 103 patients had MCA stenosis or occlusion, in which 12 were mild stenosis, 22 were moderate stenosis, 40 were severe stenosis, and 39 were occlusion. Compared to DSA, the sensitivity of TCD in detection of moderate and severe MCA stenosis or occlusion was 78. 8%, the specificity was 96. 0%, and the accuracy was 93.0%, the missed diagnosis rate was 21.2%, and the misdiagnosis rate was 4. 0%. As to the blood flow velocity, there was no sifftificant difference between the mild stenosis and normal groups; while there was significant difference between the moderate stenosis and normal groups （/9 〈 0. 001）. In addition, there was no significant difference in blood flow velocity between the moderate stenosis and severe stenosis groups. Determining the cut-off value of the best peak systolic velocity of the moderate stenosis was 163.5 cm/s, while the best cut-off value of the mean velocity was 108.5 cm/s. Conclusions TCD has certain advantages in the diagnosis of the MCA stenosis or occlusion, and it can be used as a safe and inexpensive screening means before DSA examination.
Key words:
Intracranial arterial diseases; Ultrasonography, Doppler, transcranial; Angiography, digital subtraction; Middle cerebral artery; Blood flow velocity
Transcranial Doppler
Digital subtraction angiography
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Objective To evaluate the value of transcranial Doppler ultrasonography ( TCD) in detecting the changes of cerebral hemodynamics after bilateral internal carotid artery stenting.Methods A total of 18 patients with bilateral severe internal carotid artery (ICA) stenosis ( n = 8) or severe stenosis on one side and occlusion on the other side (n = 10) were selected.TCD was used to detect the changes of hemodynamic parameters of extracranial and intracranial artery before and after stenting.Results ①TCD sensitivity for the diagnosis of ICA occlusion was 100% (10/10),the specificity for the diagnosis of stenosis or occlusion was 96% (25/26),and the overall compliance rate was 97% (35/36).②The preoperative peak systolic velocity ( PSV) of the stenotic segment of extracranial internal carotid artery (EICA) was 241 ± 55 cm/s;1,3,6,12,and 24 months after the procedure they were 59 ± 15,58 ± 12,59 ± 15, 61 ±14,and 64 ±16 cm/s,respectively.Compared to those before the procedure,the differences were statistically significant.However,comparing to the various stages after the procedure,there were no statistical differences.③PSV of middle cerebral artery ( MCA) on the stented side after the procedure was higher than that before the procedure (59 ± 14,120 ±24 cm/s,P = 0.000).Vascular pulsatility index (PI) was improved significantly (0.64 ±0.15,1.05 ±0.19 ;P =0.000).PVS of MCA occlusion after the procedure was also increased slightly (48 ±17,70 ±16 cm/s,P =0.005),while the changes of PI values was not significant (P=0.379).(4)Two patients had patent anterior communicating artery (AcoA) before the procedure,AcoA was occluded after bilateral carotid artery stenting;11 patients had patent AcoA after the procedure,and 10 of them were unilateral occlusion and stenosis on the other side.One patient had bilateral severe stenosis,but only had unilateral stenting.There were 24 (66.7% ) patent posterior communicating arteries (PcoA),18 of them were occluded after the procedure.Conclusion TCD can be used in the evaluation of the extracranial and intracranial hemodynamic changes in patients with bilateral internal carotid artery disease before,during,and after the procedure.
Transcranial Doppler
Anterior cerebral artery
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Objective To discuss the value of transcranial Doppler(TCD)in the evaluation of cerebral blood flow in patients with vertebrobasilar artery stenosis before and after percutaneous transluminal angioplasty(PTA).Methods 43 patients with vertebrobasilar artery stenosis diagnosed by digital subtraction angiography(DSA) were given TCD ultrasonography before and after PTA treatment.Blood flow indicators(Vs,Vd,PI and RI) were collected and compared with vascular morphology results of DSA.Results Before PTA,TCD examination showed that the blood flow velocity in artery with stenosis was increased with spectrum disorders,the frequency window was filled and eddy current signal could be seen,meanwhile,the RI and PI were increased and coarse vascular murmur or gull sound could be heard;blood flow signal was not detected in the initial part in one case.The abnormality rate according to TCD was 97.6%,among which 6 cases had abnormal blood flow velocity in basilar artery,28 cases in unilateral vertebral artery,8 cases in bilateral vertebral artery and one case had normal velocity.After PTA,the spectrum was normal with clear frequency window,and the blood audio signal was also normal;one case had little change.The blood flow indicators according to TCD showed statistically significant differences before and after PTA(P0.05).All the indicators had decreased to reference range.The consistent rate between TCD and DSA before PTA was 97.6%.No patient had recurrence of stenosis during the six-month following up.Conclusion TCD can provide objective evidence for evaluation of the effects before and after PTA in the treatment of vertebrobasilar artery stenosis and for the follow-up visit after PTA.Combined with the results of DSA,corresponding changes after the improvement of cerebral ischemia can be clearly known.
Transcranial Doppler
Digital subtraction angiography
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Objective:To investigate the value of carotid artery severe stenosis after endovascular stenting by Doppler sonography(TCD) and Color Doppler flow Imaging(CDFI).Methods:38 cases with carotid artery severe stenosis were examined after interventional therapy by TCD and CDFI,in order to evaluate the Carotid artery morphology and hemodynamic.Results:38 cases with the carotid artery stenosis and the degree of stenosis of more than 70%,after endovascular stenting,the diemeters increased,the blood velocity decreased,The stenosis disappeared,Open lateral branch closed,Hemodynamic the parameters improved significantly by TCD and CDFI,the results which were examined by TCD and CDFI were consistent with the results by digital subtraction angiography(DSA).Conclusion:Diagnosis by CDFI had the higher the accuracy of the carotid artery severe stenosis.TCD combined with CDFI improve the accuracy of the diagnosis about carotid artery severe stenosis and become a very important method for assessing and following up curative effect of carotid artery stent.
Digital subtraction angiography
Transcranial Doppler
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Objective To evaluate the value of TCD in diagnosis of internal carotid artery severe stenosis or occlusion. Methods Twenty-one patients with internal carotid artery severe stenosis or occlusion were examined by TCD,then DSA or MRA within one week. The results of TCD and DSA (or MRA) were compared. Results The sensitivity of TCD in diagnosis of carotid stenosis was 92.00% ,the specificity was 94.12%.The false positive rate was 5.88%. The false negative rate was 8.00% and the diagnostic accuracy was 92.86% . The accuracy of TCD in diagnosis of internal carotid artery severe stenosis or occlusion was 80.95%. The accuracy of TCD in diagnosis of stenosis degree was 69.23%. Conclusion TCD is able to be used as a screening method in diagnosis of internal carotid artery stenosis,but for judgement of internal carotid artery stenosis degree,TCD still has its limitations.
Transcranial Doppler
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Objective To evaluate the reliability of transcranial doppler(TCD)in diagnosing internal carotid artery, middle cerebral artery stenosis of cerebral infarction patients. Methods There were 45 patients with cerebral infarction who were treated in our department between 2011 June to 2012 August. They were underwent TCD and CTA examination within 1 week after hospitalization(time interval in 3 days). Results According to CTA results,the sensitivity of TCD in diagnosing internal carotid artery stenosis(occlusion, severe and moderate stenosis)was 47.1%, the specificity was93.2%, the coincidence was 84.4%;The sensitivity of TCD in diagnosing middle cerebral artery stenosis(occlusion, severe and moderate stenosis)was 40.9%, the specificity was86.8%,the coincidence was75.6%. Conclusion Diagnosis of internal carotid artery and middle cerebral artery stenosis with TCD has high specificity. Combination of TCD and CTA can improve the accuracy of the assessment of stenosis severity.
Transcranial Doppler
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Objective To evaluate the efficacy of carotid stent implantation performed on patients with carotid stenosis by color doppler flow imaging(CDIF) and transcranial doppler(TCD).Methods Forty-one carotid stenosis cases [carotid stenosis rate≥70%,confirmed by digital subtraction angiography(DSA)] who had cerebral ischemia symptoms and received stent implantation were reviewed.CDFI and TCD were adopted to measure the vessel diameter,carotid stenosis rate,peak systolic velocity(PSV)of the narrow segment,PSV and pulsatility index(PI) of ipsilateral middle cerebral artery(MCA) before and after the treatment of intravascular stents,and a comparison analysis was made.Results After the treatment of carotid stent implantation,the improvement of above indexes in patients with carotid stenosis were as following:①Inner diameter of the narrow part became widened.The inner diameter was(1.88±0.75)mm before stenting and(3.63±1.02)mm after stenting(P0.01);② PSV of the narrow part and PSV,PI of the affected side MCA turned to be normal,and all the collateral circulations closed.Before stenting the PSV of the narrow part was(197.49±64.78)cm/s,after stenting it was(82.62±36.48)cm/s(P0.01);PSV of the affected side MCA was(63.92±26.83)cm/s before stenting,and after stenting it was(87.46±18.90)cm/s(P0.01);PI of the affected side MCA from(0.67±0.35) before stenting,increased to(0.89±0.17)after stenting.Conclusions The results of CDFI and TCD indicated that the treatment of endovascular stenting could improve the vascular structures and hemodynamics,the combination of CDFI and TCD could be used in the accurate assessment and follow up of carotid artery stenting treatment.
Carotid stenting
Transcranial Doppler
Digital subtraction angiography
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Transcranial Doppler
Digital subtraction angiography
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Objective To evaluate the hemodynamics change of brain before and after vertebrobasilar angioplasty and stenting in the patients with intracal stenosis.Methods All the indexes were compared among thirty-eight patients with intracal arterial stenosis,including mean peak flow velocity,systolic peak flow velocity,and resistance index of hemodynamics ; Cerebral blood volume ( CBV),cerebral blood flow (CBF)and middle time to peak(MTT) before and after the operation.Results After vertebro-basilar angioplasty and stenting in the 38 patients,the Vs of PCA were significantly lower in the affected side [ (226 ±27)cm/s vs (135 ± 18)cm/s; t =21.74,P ＜0.01 ].Significant difference was found between pro-and post stenting of rMTT and rCBF in the blood territories of stenotic cerebrovascular ( t =3.987,P =0.001 )and( t =-2.027,P =0.029),There was no significant difference between pro-and post stenting of rCBV in the blood territories of stenotic cerebrovascular ( t =-0.901,P =0.329).Conclusions Transcranial Doppler and CT perfusion can be used to evaluate hemodynamic changes before and after pereutaneous transluminal angioplasty and stenting.
Key words:
Vertebrobasilar insufficiency/surgery; Angioplasty; Ultrasonography, doppler, transcranial; Cicatrix, hypertrophic
Transcranial Doppler
Vertebrobasilar insufficiency
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