A Combined Power M‐mode and Single Gate Transcranial Doppler Ultrasound Microemboli Signal Criteria for Improving Emboli Detection and Reliability

Choi, Young-Bin; Saqqur, Maher; Asıl, Talip; Jin, Albert; Stewart, Eileen; Stephenson, Caroline J.; Ibrahim, Mohamad; Roy, Jayanta; Boulanger, Jean-Martin; Coutts, Shelagh B.; Khan, Firosh; Demchuk, Andrew M.

doi:10.1111/j.1552-6569.2009.00446.x

Cited by 12 publications

(8 citation statements)

References 26 publications

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“…Microemboli were defined as audible, high intensity (>13db), and <100ms unidirectional signals within both Doppler blood flow velocity and vessel lumen (22). Intraobserver agreement for detection of microembolism was 96% (Kappa 0.83).…”

Section: Methodsmentioning

confidence: 99%

Libman-Sacks Endocarditis and Embolic Cerebrovascular Disease

Roldan

Sibbitt

Qualls

et al. 2013

JACC: Cardiovascular Imaging

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Objective To determine whether Libman-Sacks endocarditis is a pathogenic factor for cerebrovascular disease (CVD) in systemic lupus erythematosus (SLE). Background A cardioembolic pathogenesis of SLE CVD manifested as 1) neuropsychiatric SLE (NPSLE) including stroke and transient ischemic attacks (TIA), 2) neurocognitive dysfunction, and 3) MRI focal brain lesions has not been established. Methods A 6-year study of 30 patients with acute NPSLE (27 women, age 38±12 years), 46 age-and-sex matched SLE controls without NPSLE (42 women, age 36±12 years), and 26 age-and-sex matched healthy controls (22 women, age 34±11 years) who underwent clinical and laboratory evaluations, TEE, carotid duplex, transcranial Doppler, neurocognitive testing, and brain MRI/MRA. NPSLE patients were re-evaluated after 4.5 months of therapy. All patients were followed clinically for a median of 52 months. Results Libman-Sacks vegetations (87%), cerebromicroembolism (27% with 2.5 times more events per hour), neurocognitive dysfunction (60%), and cerebral infarcts (47%) were more common in NPSLE than in SLE (28%, 20%, 33%, and 0%) and healthy controls (8%, 0%, 4%, and 0%, respectively) (all p≤0.009). Patients with vegetations had 3 times more cerebromicroemboli per hour, lower cerebral blood flow, more stroke/TIA and overall NPSLE events, neurocognitive dysfunction, cerebral infarcts, and brain lesion load than those without (all p≤0.01). Libman-Sacks vegetations were independent risk factors of NPSLE (OR=13.4, p<0.001), neurocognitive dysfunction (OR=8.0, p=0.01), brain lesions (OR=5.6, p=0.004), and all 3 outcomes combined (OR=7.5, p<0.001). Follow-up re-evaluations in 18 (78%) of 23 surviving NPSLE patients demonstrated improvement of vegetations, microembolism, brain perfusion, neurocognitive dysfunction, and lesion load (all p≤0.04). Finally, patients with vegetations had reduced event free survival time to stroke/TIA, cognitive disability, or death (p=0.007). Conclusion The presence of Libman-Sacks endocarditis in patients with SLE is associated with higher risk for embolic CVD. This suggests that Libman-Sacks endocarditis may be a source of cerebral emboli.

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Section: Methodsmentioning

confidence: 99%

Libman-Sacks Endocarditis and Embolic Cerebrovascular Disease

Roldan

Sibbitt

Qualls

et al. 2013

JACC: Cardiovascular Imaging

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“…Emboli were defined on both the spectrogram and the power M-mode to improve reliability. 4 Embolic signals on the spectrogram were identified visually as unidirectional, short-lasting (<300 ms) signals with an amplitude of >3 dB above background and typical chirping sound. 5 Embolic signals on power M-mode were identified as at least 3 dB higher than the highest spontaneous power M-mode background blood flow, which reflect motion in 1 direction at a minimum spatial extent of 7.5 mm and temporal extent of 30 ms and must traverse a prespecified depth.…”

Section: Tcd Monitoring and Interpretationmentioning

confidence: 99%

Malignant Emboli on Transcranial Doppler During Carotid Stenting Predict Postprocedure Diffusion-Weighted Imaging Lesions

Almekhlafi

Demchuk

Mishra

et al. 2013

Stroke

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This was a prospective, single-arm, cohort study to assess the safety of each step performed during CAS procedure. Eligible subjects were identified from the Foothills Medical Center of the University of Calgary, Alberta, Canada. Subjects with carotid stenosis (any symptom-status) planned for CAS and able to provide an informed consent were included. Subjects unable to have an MRI scan or those with absent bone window for TCD monitoring were excluded. Carotid Stenting ProcedureCAS was performed under intravenous conscious sedation in all but 1 subject who required general anesthesia for severe agitation. All procedures were attended by anesthesiologists. A common femoral Background and Purpose-Carotid angioplasty and stenting (CAS) has a higher incidence of periprocedural stroke compared with endarterectomy.

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“…We used a standard protocol as described elsewhere [13] . Embolic signal interpretation was done manually by an experienced ultrasonographer based on the criteria of the International Consensus group on Microembolus Detection [15,16] . Detection of at least 1 MES ipsilateral of the stenosis resulted in a positive exam, and those patients were defined as MES+.…”

Section: Ultrasound Analysismentioning

confidence: 99%

Plasmatic biomarkers of inflammation correlate with 18FDG-PET-CT and microembolic signals in patients with carotid stenosis

Mueller¹,

Fisch²,

Bonvin³

et al. 2018

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Methods:18 FDG-PET-CT and MES detection was performed in consecutive patients with 50% to 99% symptomatic or asymptomatic carotid stenosis. Uptake index was defined by a target to background ratio (TBR) between maximum standardized uptake value of the carotid plaque and the average uptake of the jugular veins. The analysis of biomarkers included adhesion molecules [intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule 1, P-selectin and E-selectin], interleukins (IL-1, IL-6), chemokines (RANTES, monocyte chemoattractant protein 1), cytokines (tumor necrosis factor α), matrix-metalloproteases (MMP), myeloperoxidase, and lipoprotein-associated phospholipase A2.Results: There were 54 symptomatic and 57 asymptomatic patients. TBR values were significantly higher in the symptomatic compared to the asymptomatic (median 2.1 vs . 1.8, P = 0.002) and in the MES positive (MES+) compared to the MES negative (MES-) group (MES+, n = 19, median 2.3 and MES-, n = 88, median 1.8, P = 0.01). The best threshold for TBR values was of 1.9. We found a significant correlation between higher 18 FDG uptake (TBR ≥ 1.9) and the plasmatic levels of chemokine RANTES (P = 0.03) and higher levels of ICAM-1 in MES+ patients (P = 0.03). Interestingly MMP-2 levels were more important in patients with lower TBR values (P = 0.02) and MMP-3 and P-selectin in those who were MES-(respectively P = 0.001 and P = 0.009). Conclusion:In the present study, ICAM-1 was associated with the presence of thrombotically active atherosclerotic plaques, while RANTES mainly correlated with the inflammatory process. MMP-2, MMP-3 and P-selectin levels were more important in patients with stable plaques.

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A Combined Power M‐mode and Single Gate Transcranial Doppler Ultrasound Microemboli Signal Criteria for Improving Emboli Detection and Reliability

Abstract: Our combined PMD/sgTCD criteria for MES appeared to improve the yield of MES detection. Reliability in MES detection interpretation was improved when combined PMD/sgTCD criteria was applied.

Cited by 12 publications

References 26 publications

Libman-Sacks Endocarditis and Embolic Cerebrovascular Disease

Libman-Sacks Endocarditis and Embolic Cerebrovascular Disease

Malignant Emboli on Transcranial Doppler During Carotid Stenting Predict Postprocedure Diffusion-Weighted Imaging Lesions

Plasmatic biomarkers of inflammation correlate with 18FDG-PET-CT and microembolic signals in patients with carotid stenosis

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