2005
DOI: 10.1161/01.str.0000173399.20127.b3
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Can Transcranial Doppler Discriminate Between Solid and Gaseous Microemboli?

Abstract: Background and Purpose-Transcranial Doppler ultrasound can reliably detect both gaseous and solid cerebral emboli.However, conventional equipment is unable to discriminate between gaseous and solid emboli. This is a major limitation in situations in which the 2 coexist, because they may have very different clinical relevance. Recently, a novel Embo-Dop system, using insonation at 2 ultrasound transducer frequencies, has been developed. An initial study with a small sample size suggested it provided excellent d… Show more

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Cited by 66 publications
(46 citation statements)
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“…Furthermore, it has been suggested that the technique used for differentiation of solid ES is not reliable. 33 In summary, this review provides strong evidence that ES predicts future ipsilateral stroke risk in patients with large artery disease, particularly symptomatic carotid stenosis. A high frequency also is a strong risk predictor in the immediate postoperative period after CEA and during the dissection phase of CEA.…”
Section: Discussionmentioning
confidence: 82%
See 1 more Smart Citation
“…Furthermore, it has been suggested that the technique used for differentiation of solid ES is not reliable. 33 In summary, this review provides strong evidence that ES predicts future ipsilateral stroke risk in patients with large artery disease, particularly symptomatic carotid stenosis. A high frequency also is a strong risk predictor in the immediate postoperative period after CEA and during the dissection phase of CEA.…”
Section: Discussionmentioning
confidence: 82%
“…Small air bubbles, despite resulting in highintensity ES, have limited clinical significance, but are impossible to differentiate from potentially more serious solid ES using current transcranial Doppler systems. 33 Not surprisingly, associations have only been detected in situations when gaseous ES are not present, namely the dissection phase (before arterial opening) and the postoperative phase (after arterial closure). During both phases a high rate of ES predicted stroke risk and was more strongly associated than the presence or absence of ES.…”
Section: Discussionmentioning
confidence: 99%
“…First, previous reports 6 -8 have suggested that air microemboli are less damaging to the brain than solid emboli, but current TCD technology does not differentiate embolus size and composition (air versus solid). 19 If the majority of cerebral microemboli during CPB are air microbubbles, then, the full effects represented by the total HITS counts on the patient's neurological outcome would be minimal. Second, cerebral embolization during CPB may not be as important to neurological outcome as other mechanisms of brain injury such as inflammation, cerebral edema, response to the surgical insult, and ischemia.…”
Section: Discussionmentioning
confidence: 99%
“…In one study, 145 MES in 23 symptomatic carotid stenosis patients and 648 MES during 50 bubble studies were evaluated. The system was found to be neither sensitive for solid emboli (sensitivity: 50.3%, specificity: 94.2%) nor specific for gaseous bubbles (sensitivity: 95.6%, specificity: 50.3%) (30). In another study, of 1256 MES signal identified by an expert during 22 CABG operations in the left MCA, only 59.6% were correctly identified, and classified as solid or gaseous by the machine.…”
Section: Artifact Rejection and Emboli Typingmentioning
confidence: 93%