Transcranial Doppler Ultrasound Detection of Microemboli as a Predictor of Cerebral Events in Patients with Symptomatic and Asymptomatic Carotid Disease: A Systematic Review and Meta-Analysis

Best, Lawrence; Webb, Adam; Gurusamy, Kurinchi Selvan; Cheng, Suk Fun; Richards, Toby

doi:10.1016/j.ejvs.2016.05.019

Cited by 40 publications

(25 citation statements)

References 37 publications

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“…There is currently very little known about the influence of cerebral blood flow (CBF) on neurologic outcomes and whether there is any impact on the basis of cannulation site. Transcranial Doppler (TCD) is a well‐established noninvasive modality for measuring velocities and has been studied in carotid endarterectomies, cardiac surgery and in sepsis, though its role in VA‐ECMO not been extensively studied . We sought to prospectively determine whether TCD could be used to assess VA‐ECMO CBF and whether arterial cannulation site affects cerebral hemodynamics.…”

Section: Introductionmentioning

confidence: 99%

Transcranial Doppler is an effective method in assessing cerebral blood flow patterns during peripheral venoarterial extracorporeal membrane oxygenation

Salna

Ikegami

Willey³

et al. 2019

J Card Surg

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Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be life-saving in refractory cardiogenic shock but carries a risk of neurologic complications such as stroke and hemorrhage. As little is known about the effects of different peripheral VA-ECMO cannulation sites on cerebral blood flow (CBF), transcranial Doppler (TCD) was used to determine whether the cannulation site affects CBF. Methods: Thirty-seven patients receiving VA-ECMO for cardiogenic shock via axillary or femoral artery cannulation were prospectively enrolled. Measured bilateral middle cerebral artery (MCA), mean flow velocities (MFV), and pulsatility indices (PI) were the primary outcomes and adverse neurologic events were secondary outcomes. Results: The median age was 58 years (IQR 51-66) with 26 (70%) males. Median VA-ECMO flow was 3.8 L/min (IQR 3.2-4.9) with mean arterial pressures of 80 mm Hg (IQR 75-86). Nineteen patients received right axillary artery cannulation while 18 underwent femoral cannulation. Compared with the femoral group, MFV was higher in the axillary group in the right MCA (46 cm/s [IQR 26-57] vs 27 [17-36], P = 0.03) and left (43 [IQR 35-60] vs 29 cm/s [16-48], P = 0.05). Axillary PI was significantly lower compared with the femoral group (right: 0.48 cm/s [0.25-0.65] vs 0.83 [0.66-0.93], P = 0.02; left: 0.41 cm/s [0.29-0.63] vs 1.02 [0.7-1.3], P = 0.004). One axillary patient experienced a stroke with deficits.Conclusions: TCD appears to be an effective tool for indirect monitoring of CBF in patients with ECMO with limited pulsatility. Axillary artery cannulation seems to provide higher cerebral flow rates without any difference in neurologic outcomes. Future studies may incorporate TCD into regulating ECMO flows to achieve physiologic CBF. K E Y W O R D S cardiogenic shock, extracorporeal membrane oxygenation, perfusion J Card Surg. 2019;34:447-452.wileyonlinelibrary.com/journal/jocs

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Section: Introductionmentioning

confidence: 99%

Transcranial Doppler is an effective method in assessing cerebral blood flow patterns during peripheral venoarterial extracorporeal membrane oxygenation

Salna

Ikegami

Willey³

et al. 2019

J Card Surg

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“…45 However, the lack of an adequate sonographic window can limit the use of TCD ultrasonography in acute ischemic stroke, with approximately 10% of patients having a temporal bone thickness that precludes the use of ultrasonography. 3,6,45 The utility of ultrasonography is also limited by the need for an experienced clinician or technician to perform and interpret the images.…”

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confidence: 99%

Advanced imaging in acute ischemic stroke

Kilburg¹,

McNally

Havenon

et al. 2017

FOC

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The evaluation and management of acute ischemic stroke has primarily relied on the use of conventional CT and MRI techniques as well as lumen imaging sequences such as CT angiography (CTA) and MR angiography (MRA). Several newer or less-established imaging modalities, including vessel wall MRI, transcranial Doppler ultrasonography, and 4D CTA and MRA, are being developed to complement conventional CT and MRI techniques. Vessel wall MRI provides high-resolution analysis of both extracranial and intracranial vasculature to help identify previously occult lesions or characteristics of lesions that may portend a worse natural history. Transcranial Doppler ultrasonography can be used in the acute setting as a minimally invasive way of identifying large vessel occlusions or monitoring the response to stroke treatment. It can also be used to assist in the workup for cryptogenic stroke or to diagnose a patent foramen ovale. Four-dimensional CTA and MRA provide a less invasive alternative to digital subtraction angiography to determine the extent of the clot burden and the degree of collateral blood flow in large vessel occlusions. Along with technological advances, these new imaging modalities are improving the diagnosis, workup, and management of acute ischemic stroke— roles that will continue to expand in the future.

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“…Cerebral microemboli are clinically silent but detectable by transcranial Doppler monitoring as high‐intensity transient signals. The presence of microembolic signals (MES) is an independent risk factor for future ischemic stroke in large‐vessel atherosclerosis and a frequent finding in other embolic causes of stroke . MES detection can be used to clarify the cause of stroke, discover circulating emboli in the acute phase of stroke or during interventions, and assess the effect of antithrombotic treatment …”

Section: Introductionmentioning

confidence: 99%

Persistent Microembolic Signals in the Cerebral Circulation on Transcranial Doppler after Intravenous Sulfur Hexafluoride Microbubble Infusion

Aarli

Novotný

Thomassen

et al. 2019

Journal of Neuroimaging

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BACKGROUND AND PURPOSE Microembolic signals (MES) are detectable by transcranial Doppler monitoring and associated with increased risk of first or recurrent ischemic stroke. MES detection can also illuminate stroke etiology and the effect of prophylactic treatment. MES detection cannot accurately distinguish between stroke‐related microemboli and ultrasound contrast agents. These agents contain microbubbles and are frequently used in neuro‐ and cardiovascular diagnostics. We aimed to assess how long after contrast infusion microbubbles are detectable by transcranial Doppler monitoring. METHODS Ten healthy volunteers received an intravenous infusion of stabilized sulfur hexafluoride microbubbles (SonoVue®) for 30 minutes. The infusion was followed by continuous unilateral Doppler monitoring (TCD‐X, Atys Medical, Soucieu‐en‐Jarrest, France) for 3.5 hours. RESULTS MES persisted for 12 to 77 minutes (median 40.5 minutes), and the frequency tended to decrease gradually until cessation. CONCLUSIONS None of the subjects had detectable MES for more than 77 minutes after ultrasound contrast infusion. MES detection with the intent to detect stroke‐related microemboli should wait for at least this long after completed infusion.

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Transcranial Doppler Ultrasound Detection of Microemboli as a Predictor of Cerebral Events in Patients with Symptomatic and Asymptomatic Carotid Disease: A Systematic Review and Meta-Analysis

Abstract: Introduction -Identification of patients who will benefit from carotid endarterectomy is not entirely

Cited by 40 publications

References 37 publications

Transcranial Doppler is an effective method in assessing cerebral blood flow patterns during peripheral venoarterial extracorporeal membrane oxygenation

Transcranial Doppler is an effective method in assessing cerebral blood flow patterns during peripheral venoarterial extracorporeal membrane oxygenation

Advanced imaging in acute ischemic stroke

Persistent Microembolic Signals in the Cerebral Circulation on Transcranial Doppler after Intravenous Sulfur Hexafluoride Microbubble Infusion

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