Consensus on Microembolus Detection by TCD

Ringelstein, E. Bernd; Droste, Dirk W.; Babikian, Viken L.; Evans, David H.; Grosset, Donald; Kaps, Manfred; Markus, Hugh S.; Russell, David; Siebler, Mario

doi:10.1161/01.str.29.3.725

Cited by 564 publications

(230 citation statements)

References 33 publications

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“…The following definition of MES was used: typical visible and audible (click, chirp, whistle) short-duration, high-intensity signal within the Doppler flow spectrum with a time delay in the 2 channels of each side. 10 Single MES within clusters were discriminated by reducing the amplification during off-line analysis.…”

Section: Vascular Ultrasound Investigationsmentioning

confidence: 99%

“…In case of a RLS, the contrast agent enters the arterial circulation and produces microembolic signals (MES) during the TCD recording, thus mimicking the pathway of paradoxical cerebral emboli. 9,10 There is no doubt that the performance of a VM increases the sensitivity of contrast TCD. Recent data suggest that the combination of the results of 2 contrast TCD tests with a provocation maneuver considerably increases the sensitivity of the method.…”

mentioning

confidence: 99%

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Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Droste

Silling

Stypmann

et al. 2000

Stroke

Self Cite

109

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Background and Purpose-Cardiac right-to-left shunts can be identified by transesophageal echocardiography (TEE) and by transcranial Doppler ultrasound (TCD) with the use of contrast agents and a Valsalva maneuver (VM) as provocation procedure. Currently, data on the appropriate timing of the VM, the use of a diagnostic time window, and a threshold in contrast agent microbubbles detected are insufficient. Methods-Fifty-eight patients were investigated by both TEE and bilateral TCD of the middle cerebral artery. The following protocol with injections of 10 mL of the commercial galactose-based contrast agent Echovist was applied in a randomized way: (1) no VM, (2) VM for 5 seconds starting 2 seconds after the beginning of contrast injection, (3) VM for 5 seconds starting 5 seconds after the beginning of contrast injection, (4) VM for 5 seconds starting 8 seconds after the beginning of contrast injection, and (5) repetitive short VMs in between 2 and 13 seconds after the beginning of contrast injection. In addition to the single tests, we also tested the sensitivity and specificity of combined results of the tests with VM. Results-In 21 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt positive). Twenty-one patients were negative in both investigations, no patient was positive on TEE and negative on TCD, and 16 patients were only positive on at least 1 TCD investigation but negative during TEE. Test 3 was the most appropriate test when combined with the results of 1 of the other tests with VM. The highest sensitivities were achieved with a diagnostic time window of 40 seconds and when the presence of a single microbubble was sufficient for the diagnosis of a shunt. Conclusions-TCD performed twice with 2 provocation maneuvers with Echovist is a sensitive method to identify TEE-proven cardiac right-to-left shunts. The VM should be performed for 5 seconds starting at 5 seconds after the beginning of contrast injection.

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Section: Vascular Ultrasound Investigationsmentioning

confidence: 99%

mentioning

confidence: 99%

Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Droste

Silling

Stypmann

et al. 2000

Stroke

Self Cite

109

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“…Nos últimos anos, diferentes consensos foram utilizados para determinadas investigações com o uso do DTC 4,5,11,12 . Este método vem se tornando um exame i m p o rtante na prática clínica, principalmente de auxí-lio ao médico interessado em doenças vasculares encefálicas, possibilitando a confirmação ou excluindo em muitas situações a hipótese clínica de maneira prática e rápida.…”

Section: Discussionunclassified

Doppler transcraniano na prática neurológica

Zétola

Lange

Muzzio³

et al. 2006

Arq. Neuro-Psiquiatr.

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O Doppler transcraniano (DTC) é um método relativamente novo, descrito em 1982 por Rune Aaslid e introduzido no Brasil em 1992 por Roberto Hirsch, na Universidade de São Paulo. O serviço de Neurologia do Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) disponibilizou esse exame em 2001, com divulgação das principais vantagens do método no diagnóstico, seguimento e manejo terapêutico de pacientes com suspeita ou portadores de doença cerebrovascular. O objetivo deste trabalho é demonstrar como o DTC vem sendo utilizado em nosso meio e quais são as especialidades médicas que vêm absorvendo o auxílio do método. Embora diretrizes como a publicada pela Academia Americana de Neurologia em 2004 validem as indicações do DTC, estabelecendo especificidade e sensibilidade do método, verificamos que a solicitação do exame em nosso meio depende da divulgação do serviço, da implementação de linhas de pesquisa e, finalmente, do reconhecimento de sua utilidade na prática diária.

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“…One of us (RP) counted the microemboli manually ''offline'' (ie, after the operation) using their unique auditory and visual characteristics. International consensus criteria were used for defining microemboli [61].…”

Section: Methodsmentioning

confidence: 99%

Cerebral Microembolization during Primary Total Hip Arthroplasty and Neuropsychologic Outcome: A Pilot Study

Patel

Stygall

Harrington

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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BackgroundIntraoperative cerebral microembolization occurs in a substantial proportion of patients undergoing THA. Historically, postoperative cognitive dysfunction has been attributed to different factors, including anesthesia, but the influence of the surgery has not been thoroughly examined. Questions/purposes We conducted a prospective, controlled clinical trial to assess intraoperative cerebral microembolization during THA and neuropsychologic outcome. Methods The presence of a patent foramen ovale (PFO) also was investigated, using transcranial Doppler, to determine whether this affected cerebral microembolic incidence and load and whether microemboli occurred as a result of specific surgical activity. Forty-five patients were recruited who underwent THA and neuropsychologic assessment; a battery of tests was administered preoperatively and at 6 weeks and 6 months postoperatively. Results Overall, patients showed improvement in total neuropsychologic change scores at both postoperative intervals. The incidence of cerebral microembolization for THA was 23%. The prevalence of PFO was 37%. PFO did not appear to influence microemboli load or incidence. More microemboli were seen during femoral component insertion and impaction. Conclusions Intraoperative cerebral microembolization occurs in a substantial proportion of patients during THA recorded by transcranial Doppler. The microemboli load is low and is not influenced by the presence of PFO. Certain surgical activities seem responsible for greater cerebral microemboli generation. However, neuropsychologic outcome was not affected postoperatively by microemboli or other operative or patient variables.

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Consensus on Microembolus Detection by TCD

Cited by 564 publications

References 33 publications

Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Doppler transcraniano na prática neurológica

Cerebral Microembolization during Primary Total Hip Arthroplasty and Neuropsychologic Outcome: A Pilot Study

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