Evaluation of the Combined Application of Ultrasound Imaging Techniques for Middle Cerebral Artery Stent Surveillance and Follow-Up Study

Abstract

ObjectiveIn recent years, cerebral artery stenting has become an effective method for the treatment of cerebral artery stenosis. However, methods for assessing efficacy and techniques for follow-up imaging still need to be developed. This study was designed to evaluate the application of transcranial color-coded sonography (TCCS) in assessing stenting of middle cerebral artery (MCA) stenosis. And, two new imaging techniques (vascular enhancement technology (VET) and 3-dimensional (3D) imaging) were tried out and evaluated.MethodWe enrolled 43 patients with cerebral artery stenosis for vascular stent implantation. All patients were examined by ultrasonography and confirmed through digital subtraction angiography. The stenosis was imaged and blood flow parameters were analyzed before and after the procedure using TCCS. VET and 3D imaging model were used in part of the patients. Important postoperative hemodynamic changes were noted.Results1) Adequate stent image was present in 41 out of 43 patients as detected by postoperative 2-dimensional imaging. Images lacking clarity were obtained in 2 patients. 2) The perioperative and postoperative (one week follow-up) instantaneous blood flow velocity at the site of stenosis was significantly decreased (P<0.05) when compared with preoperative levels. Differences between postoperative (one week follow-up) and preoperative blood flow velocity were significant (P<0.05). Differences in blood flow velocity at long-term follow-up (six months and two years) compared to one-week values were not statistically significant (P>0.05). 3) VET imaging visualizes the MCA lumen and stent morphology clearly. 3D ultrasound can be used for imaging of the stent shape as well as its inner surface.ConclusionTCCD can be considered a quick and effective clinical detection method to evaluate the intracranial arterial hemodynamics changes before and after stenting treatment for MCA stenosis. New imaging technologies 3D and VET can achieve additional image information.

Perfusion-weighted magnetic resonance imaging in the assessment of haemodynamics following stent angioplasty in patients with symptomatic middle cerebral artery plaque stenosis at the M1 segment

“…However, as with other endovascular procedures, an effective and convenient method of assessing treatment efficacy and follow-up has not yet been developed. Furthermore, there is insufficient research available to detect the haemodynamic changes that occur following stent placement ( 10 ).…”

“…Digital subtraction angiography (DSA) is the gold standard for diagnosing intracranial arterial stenosis; however, it is expensive, invasive and unable to detect haemodynamic changes. Therefore, DSA cannot be executed within a short time frame and cannot be used for follow-up testing following stent placement ( 10 ). Due to developments in medical imaging technology, various methods exist to study the haemodynamics of these patients, comprising computed tomographic perfusion ( 11 ), positron emission tomography (PET) and single photon emission computed tomography (SPECT) ( 12 ).…”

Evaluation of Interventional Therapy for Patients with Intracranial Vertebral Artery Stenosis by Transcranial Color-Coded Sonography

“…However, only a few case reports have addressed the application of TCCS in cerebral arterial stenting (Oehm et al 2002;Vicenzini et al 2007). In 2013, the results of a 2-y follow-up on middle cerebral artery stenting were reported by Wang et al (2013). In this study, the immediate relief in stenosis, accompanied by a decrease in flow velocity, indicated that TCCS could be used for assessing treatment efficacy.…”

“…Repeated DSA tests within a short span for follow-up after stenting are still limited. Recently, trans-cranial color-coded sonography (TCCS) was reported to be an effective tool for intracranial stenting evaluation (Moreira et al 2012;Wang et al 2013). However, evaluations of the clinical application of TCCS in the management of stenting for IVAS have been lacking.…”

Transcranial Color-Coded Duplex Sonography and Digital Subtraction Angiography in Acute Stroke Patients

“…TCCS has some advantages in diagnosing intra-axial intracranial hematomas (intraparenchymal hematomas), extra-axial intracranial hematomas (epidural and subdural hematomas), brain midline shift, hydrocephaly, brain tumors, cerebral aneurysms, and arteriovenous malformations [21]. Although real-time dynamic morphological information is achieved via color or power Doppler ow imaging of TCCS [23], it has been reported that only 55-80% of basal cerebral arteries can be determined via unenhanced TCCS [24].…”