Transcranial Doppler ultrasound changes before and after stent assisted angioplasty of middle cerebral artery stenosis
0
Citation
0
Reference
20
Related Paper
Abstract:
Objective: To observe the middle cerebral artery(MCA) flow velocity changes after stent assisted angioplasty of symptomatic MCA stenostic patients. Methods: Twenty-two MCA stenostic patients underwent stent assisted angioplasty. Transcranial Doppler ultrasound(TCD) was performed before and after treatment. Results: ①TCD findings before treatment: the velocity of MCA is remarkably increased in MCA stenostic patients. ②TCD changes after treatment: most patients' MCA velocity decreased in different degrees, one case appeared transient ischemic attack(TIA) due to MCA spasm. ③During follow-up over 1～15 months(mean 4.6 months), one case appeared restenosis after 11 months. The remaining patients experienced alleviation of symptoms without TIA and apoplexy during short term follow up. Angiograph showed that the stenostic degree reduced from 82% to 5%. Follow up by TCD showed good patency of stented lesions. The TCD diagnosis is consistent with DSA. Conclusions: TCD is a sensitive means to diagnose MCA stenosis, and to assess the effect of stent assisted angioplasty. It can be used to evaluate the results of treatment and as a tool of follow-up.Keywords:
Transcranial Doppler
Cite
Objective In order to evaluate and follow the effect of carotid stent used by the combined result of color duplex flow imaging (CDFI) and transcranial Doppler (TCD). Methods 53cases (47 male, 6female, aged from 41 - 83 years, mean (64. 26±9. 63)years) with carotid artery stenosis were investigated pre-post stent treatment 1 to 24 month. . The diameter of vessels, percent of stenosis, index of hemodynamicsintra-extracranial artery were recorded and compared respectively. Results 53 cases with carotid artery stenosis were successfully managed by carotid aetery stent. None of these patients happened is-chemic symptoms again after procedure. The diameter of carotid artery was increased from (1. 644±0. 817) mm to(4. 150±0. 642) mm( P = 0. 000) by means of CDFI. The percent of stenosis of vessels were reduced significantly. Angiography and CDFI showed the stenosis of percent from (84. 63±11. 41)% to (14. 37±6.6. 1)% and (84. 84 ±10. 09)% to (14. 85±8. 4)% (P = 0. 000) respectively. The velocity of MCA improved 20% -189% was detected by TCD, mean value was (63±34)% after carotid artery stent, pulsatilty index (PI) of MCA were changed from 0. 76±0. 17 to 1. 04±0. 14(P = 0. 000) . Intracranial collateral circulation was opened before stent placement; while it was closed post procedure. The changes of velocity of MCA and PCA were mutually related to the intracranial collateral circulation. Conclusion According to the result of combing CDFI and TCD clued on the really gist of hemodynamics extra-intracranial pre-postoperation, it is very important method for assessing and following the curative effect of carotid artery stent.
Transcranial Doppler
Collateral circulation
Cite
Citations (0)
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
Cite
Citations (0)
To emphasize the integrated use of transcranial Doppler ultrasonography (TCD) in the management of internal carotid artery (ICA) closure.Thirty-three patients being considered for ICA closure underwent TCD assessment, vasomotor reserve testing/estimation, and carotid artery test occlusion with concomitant middle cerebral artery (MCA) blood velocity (V(MCA)) monitoring, including calculation of the MCA pulsatility index. Twelve of these patients proceeded to undergo ICA sacrifice. Sequential TCD sonograms guided their postoperative treatment.ICA aneurysms and neck neoplasms affected the TCD results and vasomotor reserve insignificantly, whereas carotid-cavernous fistulae induced characteristic circulatory alterations. The 10 subjects who tolerated ICA sacrifice hemodynamically all showed an initial decrease in the ipsilateral V(MCA) to > or =60% of the preocclusion value and a progressively decreasing MCA pulsatility index during carotid artery test occlusion. The two patients who developed hemodynamic cerebral infarctions exhibited a decrease in V(MCA) to <60% and a MCA pulsatility index that remained stable after a vast initial reduction. Postoperative hypervolemic and hypertensive support was safely titrated in all patients who received postoperative TCD surveillance, providing an ipsilateral V(MCA) of > or =80% of the preocclusion value. ICA closure permanently altered the cerebral circulatory pattern.The hemodynamic outcome of ICA sacrifice can be correctly predicted by using the TCD occlusion test. TCD provides the means to titrate the extent of postoperative hypervolemic/hypertensive support.
Transcranial Doppler
Cite
Citations (17)
Objective To analyze the potential causes of abnormal hemodynamic changes after stenting in se- lected patients with symptomatic middle cerebral artery(MCA)stenosis.Methods Patients with symptomatic MCA stenosis underwent MCA stenting if they had recurred symptoms of cerebral ischemia while receiving an- tiplatelet therapy.Transcranial Doppler(TCD)examination was performed before and 3 days after stenting.The causes of abnormal hemodynamics were analyzed by TCD spectra,clinical symptoms and neuroimaging.Results Among the 29 patients(31 stenotic MCA),TCD spectra in 27 MCA restored to nearly normal level after stenting. The stenosis-like spectra at stenotic segment appeared in four patients(four MCA)within 3 days after stenting and 2 patients occurred intracranial hemorrhagic changes on CT scans.The potential causes were hyperperfusion syn- drome with 3 patients,and another severe stenosis was found at down branch of MCA in 1 patient.Conclusion The potential causes may be hyperperfusion syndrome or phenomenon and stenosis of other branch of MCA in pa- tients with stenosis removing on angiography but stenosis-like spectra on TCD after stenting.
Transcranial Doppler
Cite
Citations (0)
Objective To explore the application value oftranscranial doppler (TCD) in carotid endarterectomy (CEA) through monitoring the hemodynamic changes of intracranial arteries during the perioperative period.Methods Eighty-two patients with internal carotid artery stenosis (ICAS),admitted to our hospital from January 2012-January 2013,were chosen in our study.Preoperative,intraoperative and postoperative TCD evaluations on these patients accepted CEA were performed; degrees of artery stenosis and fluency of lateral branch of the patients before CEA were evaluated; microembolic signals (MESs) and hemodynamics of the middle cerebral artery (MCA) in the surgery side were monitored during the perioperative period; the MCA velocity (VMCA) and the states of collateral circulation were observed after CEA.Results All 82 patients showed severe ICAS,low blood VMCA and low pulsatility index of MCA; anterior and posterior communicating branch did not exist in 6 patients; the other 76 patients showed different status of communicating artery.MESs were captured immediately after opening the clamp of common carotid artery (CCA) in 31 patients; when the ipsilateral CCA was clamped,2 patients showed a rapidly decreased VMCA to 0 cm/s,and a vascular shunt was used to ensure the brain blood supply.About 93.9％ patients presented an increase in the blood velocity and pulsatility index ofipsilateral MCA,together with a subsequent close of collateral circulation; over 1.5 times increase of VMCA was observed in about 24.7％ patients.Acute cerebral infarction in one patient occurred on the same day of CEA.Conclusions TCD could assess the hemodynamics of the contralateral MCA and the closure of collateral communication,thus,helping us predict the hyperperfusion and analyze the pathogenesis of cerebral infarction during perioperative CEA.
Key words:
Carotid endarterectomy; Transcranial color Doppler; Blood flow dynamics; Carotid artery stenosis
Transcranial Doppler
Collateral circulation
Cite
Citations (0)
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
Cite
Citations (0)
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.
Transcranial Doppler
Digital subtraction angiography
Cite
Citations (0)
OBJECTIVE To study the clinical valueof transcranial Doppler test (TCD) in monitoring the ce-rebral hemodynamic changes during carotid pressuretraining before resection of the tumor and carotidsegment. METHODS The bilateral blood velocity varia-tion of anterior cerebral antery(ACA), middle cerebralartery(MCA)in the 14 patients after obstructed the ca-rotid artery was measured by TCD through temporalwindows. RESULTS Nine of the fourteen patients(64.3%), whose Willis ring compensatory ability wereinsufficient through the examination of TCD and DSA ,had the ring opened well after receiving the carotid pres-sure training for 2 to 6 weeks , and their cerebral collat-eral circulations were reconstructed well through theobservation of TCD. All blood flow velocity of the af-fected side of ACA, MCA had reached the level of unob-structed sides. There were significant differences in av-erage of ACA, MCA blood flow velocity before and aftertraining(ACA:t =19.278,P 0.05 ; MCA:t =22.278,P 0.05). No one died during operation and no cerebralvascular complications occurred. All of the 14 caseshad no recurrence after followed-up for more than 1 year.CONCLUSION TCD is a non-invasive, safe, reliableand well-repeated method to monitor the cerebral bloodvelocity. It is important for patients with carotid invaded.
Transcranial Doppler
Collateral circulation
Cerebral circulation
Circle of Willis
Cite
Citations (0)
A 46-year-old Chinese man presented with left-sided weakness of sudden-onset for 145-minutes. His cardiovascular risk factors included hypertension and hypercholesterolemia. Neurological examination revealed left hemiplegia (Medical Research Council power grade 0/5) with National Institute of Health Stroke Scale (NIHSS) score of 16-points. An urgent non-contrast brain computed tomography (CT) scan was unremarkable while CT angiography revealed acute occlusion of the proximal right middle cerebral artery (MCA) (Fig. 1A). Treatment with intravenous tissue plasminogen activator (IV-tPA) was initiated at 175-minutes from symptom-onset. Continuous transcranial Doppler (TCD) monitoring of right MCA flow was performed using 2-MHz ultrasound transducer (Supplementary movie 1). No flow signals were noted in right MCA at the time of IV-tPA initiation. At 16-minutes, minimal antegrade flow (Fig. 2A) appeared in the right MCA that improved rapidly normal flow spectra within few seconds (Fig. 2B and C).1) Improvement in TCD flow signals was accompanied by rapid neurological recovery (NIHSS score decreased to 3-points at 20-minutes). He continued to improved and recovered considerably by day 2. CT angiography performed on day 2 revealed complete recanalization of the right MCA (Fig. 1B).
Fig. 1
A: Pre-treatment computed tomographic angiography (CTA) of the brain shows a filling defect in the proximal right middle cerebral artery. B: The image shows the CTA performed on day 2, showing complete recanalization.
Fig. 2
Continuous transcranial Doppler monitoring of the right middle cerebral artery (MCA) was performed to evaluate its patency. A: The image shows the minimal grade flow signals in the right MCA at 16 minutes that improved during next few seconds (B), rapidly ...
IV-tPA is the only approved therapeutic agent for achieving arterial recanalization in acute ischemic stroke. TCD is a noninvasive and bedside technique that can witness arterial recanalization in real-time during intravenous thrombolysis.2) Various randomized and observational studies provide an indication of the biological effect of TCD ultrasound in enhancing the effect of IV-tPA induced thrombolysis without any compromise on its safety regarding symptomatic intracranial hemorrhage.3) Our case demonstrates the rarely witnessed arterial recanalization of right MCA in real-time during intravenous thrombolysis and continuous TCD monitoring.
Transcranial Doppler
Stroke
Neurological examination
Cite
Citations (2)
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
Cite
Citations (0)