Application of transcranial Doppler in cerebrovascular diseases.
Frontiers in aging neuroscience
Transcranial Doppler (TCD) is a rapid and non-invasive diagnostic technique that can provide real-time measurements of the relative changes in cerebral blood velocity (CBV). Therefore, TCD is a useful tool in the diagnosis and treatment of clinical cerebrovascular diseases (CVDs). In this review, the basic principles of TCD and its application in CVD were outlined. Specifically, TCD could be applied to evaluate occlusive CVD, assess collateral circulation in patients with ischemic stroke, and monitor cerebral vascular occlusion before and after thrombolysis as well as cerebral vasospasm (VSP) and microembolization signals after aneurysmal subarachnoid hemorrhage (SAH). Moreover, TCD could predict short-term stroke and transient cerebral ischemia in patients with anterior circulation occlusion treated with endovascular therapy and in patients with anterior circulation vascular occlusion. Additionally, TCD not only could monitor blood velocity signals during carotid endarterectomy (CEA) or carotid artery stenting (CAS) but also allowed earlier intervention through early recognition of sickle cell disease (SCD). Presently, TCD is a useful prognostic tool to guide the treatment of CVD. On the one hand, TCD is more commonly applied in clinical research, and on the other hand, TCD has an increasing role in the management of patients. Collectively, we review the principles and clinical application of TCD and propose some new research applications for TCD.
10.3389/fnagi.2022.1035086
The Value of Contrast-Enhanced Ultrasound in the Evaluation of Carotid Web.
Frontiers in neurology
Objectives:The purpose of this study was to investigate whether contrast-enhanced ultrasound (CEUS) is more advantageous than conventional ultrasound in the diagnosis of carotid web (CaW) and to compare the clinical characteristics of patients in different age groups. Methods:Seventeen patients admitted to the hospital from October 2019 to December 2021 were included in our study. Patients were initially diagnosed with CaW using digital subtraction angiography (DSA), and conventional ultrasound and CEUS were completed. Baseline patient data were analyzed and compared between the <60 years old CaW group and the ≥60 years old CaW group to explore the differences between the two groups. Then, comparing the accuracy of conventional ultrasound and CEUS. Results:A total of 17 CaW patients participated in this study, including 4 female patients (23.5%) and 13 male patients (76.5%), with an average age of 59.41 (±10.86) years. There were 9 patients (52.9%) with left CaW and 8 patients (47.1%) with right CaW. Acute ischemic stroke (AIS) occurred in 14 patients (82.4%). Thrombosis occurred in five of 17 patients (29.4%). There was a significant statistical difference about the thrombosis between the <60 years old CaW group and the ≥60 years old CaW group [<60 years group: 0 (0%), ≥60 years group: 5 (62.5%), = 0.005]. Seven patients (41.2%) received medical management, nine patients (52.9%) had carotid artery stenting (CAS), and one patient (5.9%) had carotid endarterectomy (CEA). None of the patients had recurrent stroke during the follow-up period. The diagnostic rate of CaW and thrombus by CEUS was higher than that by conventional ultrasound, and there was a significant statistical difference in the diagnosis of thrombus between CEUS and conventional ultrasound (χ2 = 4.286, = 0.038). Conclusions:CEUS may have a higher diagnostic accuracy for CaW with thrombosis, and it has a higher clinical application prospect.
10.3389/fneur.2022.860979
Ultrasound characteristics of carotid web.
Journal of neuroimaging : official journal of the American Society of Neuroimaging
BACKGROUND AND PURPOSE:Carotid web (CaW) is a cause of recurrent ischemic stroke that remains underdiagnosed using Duplex ultrasound (DUS). Improved methods and description of its ultrasound's features could allow better detection of CaW. Ultrasound microflow imaging (MFI) is a blood flow imaging technique sensitive to slow flow that could increase CaW detection. This study aimed to describe ultrasound features of CaW using B-mode imaging and MFI. METHODS:In a retrospective monocentric study, patients with CaW on CT angiography who underwent DUS examination of carotid arteries were included. DUS was performed by two nonblinded experienced neurosonologists. The specificity of CaW ultrasound features was evaluated using a group of patients with carotid atherosclerotic plaque (AP). RESULTS:Twenty-four patients with CaW were included. Mean age (standard deviation) was 48 years (11). Seventeen (71%) were females. Fifteen (63%) CaWs were symptomatic. MFI was available for 22 patients. B-mode imaging demonstrated the characteristic CaW appearance in 19/24 (79%) patients as a protruding triangular iso-hypoechoic lesion on longitudinal view. CaW were detected on axial view in only 9/24 (38%) patients. MFI displayed slow blood flow above CaW during systole and allowed it delineation, appearing as a thin triangular endoluminal defect in 18/22 (82%) cases. Based on MFI and B-mode, 21/22 (95%) CaWs were visible, including three CaWs only with MFI. These ultrasound features were not found among 24 patients with AP. CONCLUSION:We report the ultrasound features from a series of 24 CaW. The use of MFI in addition to B-mode imaging improved the detection rate of CaW.
10.1111/jon.13022
Transient ischemic attack due to dynamic evolution of carotid artery web.
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Carotid artery web (CaW) is a rare focal fibromuscular dysplasia, which is an underappreciated risk factor for transient ischemic attack. This case illustrates the dynamic evolution of secondary thrombus and plaque in CaW, and the importance of carotid doppler ultrasound in early detection and follow-up.
10.1007/s10072-023-06816-7
Sonographic Evaluation of Complications of Extracranial Carotid Artery Interventions.
Millet John D,Cavallo Joseph J,Scoutt Leslie M,Gunabushanam Gowthaman
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
Carotid endarterectomy and carotid artery stenting are among the most common peripheral vascular procedures performed worldwide. Sonography is the initial and often only imaging modality used in the evaluation of iatrogenic carotid arterial injuries. This pictorial essay provides an overview of the clinical and sonographic findings of complications after interventions in the extracranial carotid arteries, including dissection, fluid collections, pseudoaneurysm, thrombosis, thromboembolism, restenosis, and stent deformation. Grayscale, color, and pulsed Doppler imaging findings are reviewed, and correlations with computed tomography, magnetic resonance imaging, and angiography are provided.
10.1002/jum.14376
Carotid Plaque-RADS: A Novel Stroke Risk Classification System.
JACC. Cardiovascular imaging
BACKGROUND:Carotid artery atherosclerosis is highly prevalent in the general population and is a well-established risk factor for acute ischemic stroke. Although the morphological characteristics of vulnerable plaques are well recognized, there is a lack of consensus in reporting and interpreting carotid plaque features. OBJECTIVES:The aim of this paper is to establish a consistent and comprehensive approach for imaging and reporting carotid plaque by introducing the Plaque-RADS (Reporting and Data System) score. METHODS:A panel of experts recognized the necessity to develop a classification system for carotid plaque and its defining characteristics. Using a multimodality analysis approach, the Plaque-RADS categories were established through consensus, drawing on existing published reports. RESULTS:The authors present a universal classification that is applicable to both researchers and clinicians. The Plaque-RADS score offers a morphological assessment in addition to the prevailing quantitative parameter of "stenosis." The Plaque-RADS score spans from grade 1 (indicating complete absence of plaque) to grade 4 (representing complicated plaque). Accompanying visual examples are included to facilitate a clear understanding of the Plaque-RADS categories. CONCLUSIONS:Plaque-RADS is a standardized and reliable system of reporting carotid plaque composition and morphology via different imaging modalities, such as ultrasound, computed tomography, and magnetic resonance imaging. This scoring system has the potential to help in the precise identification of patients who may benefit from exclusive medical intervention and those who require alternative treatments, thereby enhancing patient care. A standardized lexicon and structured reporting promise to enhance communication between radiologists, referring clinicians, and scientists.
10.1016/j.jcmg.2023.09.005
Extracranial and transcranial ultrasound assessment in patients with suspected positional 'vertebrobasilar ischaemia'.
Sultan M J,Hartshorne T,Naylor A R
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
OBJECTIVES:A diagnosis of 'positional' vertebrobasilar ischaemia is considered in patients presenting with dizziness/vertigo during lateral neck rotation/extension and is attributed to bony 'nipping' of the vertebral artery (VA). This study reviewed our experience with extracranial and transcranial ultrasound to determine whether a diagnosis of 'positional' vertebrobasilar ischaemia was associated with any changes in flow in the extracranial VA and the P1 segment of the posterior cerebral artery (PCA) during head turning. METHODS:A retrospective case note review was undertaken in 46 patients with an accessible window for transcranial Doppler who had undergone extracranial and transcranial assessment of flow velocity and flow directionality in the VA and PCA while the head was moved into positions that normally triggered the patient's symptoms. RESULTS:Positional 'vertebrobasilar symptoms' were triggered by lateral head rotation in 35 patients (76%), while 11 (24%) developed symptoms following neck extension. Only one patient was found to have a significant carotid stenosis (symptoms unchanged following carotid endarterectomy) and none had significant disease in the extracranial VAs. None of the patients exhibited any change in extracranial VA flow during head turning/extension and none had reversal of flow either. Similarly, there was no change observed in the PCA flow characteristics during head turning. The majority of patients (74%) were subsequently referred to the Ear, Nose and Throat (ENT) department, and 94% of the patients noted an improvement in symptoms following entry into a vestibular rehabilitation programme. CONCLUSIONS:A diagnosis of 'positional' vertebrobasilar ischaemia should be made with extreme caution and only after a specialist assessment in a Balance Centre.
10.1016/j.ejvs.2008.12.006
[Evaluating the extracranial cerebral arteries with ultrasound angiography].
Krünes U,Bürger K
Ultraschall in der Medizin (Stuttgart, Germany : 1980)
AIM:Ultrasound angiography is a new method of colour-coded vessel imaging. The present study aimed at giving further information on its clinical utility in neurosonology. METHOD:The extracranial arteries of 53 patients and 5 normal persons were investigated by ultrasound angiography in comparison with colour-coded duplex sonography. RESULTS:We found a sharper imaging of stenoses and plaques by ultrasound angiography compared with colour Doppler. The imaging of the vessels can be achieved more continuously, avoiding dropouts of the colour. Small vessels and branches can be detected more reality. CONCLUSION:Ultrasound angiography represents a valuable additional imaging technique to colour-coded duplex sonography, providing further information, especially with regard to the border of plaques and stenoses.
10.1055/s-2007-1003991
Early Diagnosis of Intracranial Internal Carotid Artery Stenosis Using Extracranial Hemodynamic Indices from Carotid Doppler Ultrasound.
Bioengineering (Basel, Switzerland)
Atherosclerotic intracranial internal carotid artery stenosis (IICAS) is a leading cause of strokes. Due to the limitations of major cerebral imaging techniques, the early diagnosis of IICAS remains challenging. Clinical studies have revealed that arterial stenosis may have complicated effects on the blood flow’s velocity from a distance. Therefore, based on a patient-specific one-dimensional hemodynamic model, we quantitatively investigated the effects of IICAS on extracranial internal carotid artery (ICA) flow velocity waveforms to identify sensitive hemodynamic indices for IICAS diagnoses. Classical hemodynamic indices, including the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI), were calculated on the basis of simulations with and without IICAS. In addition, the first harmonic ratio (FHR), which is defined as the ratio between the first harmonic amplitude and the sum of the amplitudes of the 1st−20th order harmonics, was proposed to evaluate flow waveform patterns. To investigate the diagnostic performance of the indices, we included 52 patients with mild-to-moderate IICAS (<70%) in a case−control study and considered 24 patients without stenosis as controls. The simulation analyses revealed that the existence of IICAS dramatically increased the FHR and decreased the PSV and EDV in the same patient. Statistical analyses showed that the average PSV, EDV, and RI were lower in the stenosis group than in the control group; however, there were no significant differences (p > 0.05) between the two groups, except for the PSV of the right ICA (p = 0.011). The FHR was significantly higher in the stenosis group than in the control group (p < 0.001), with superior diagnostic performance. Taken together, the FHR is a promising index for the early diagnosis of IICAS using carotid Doppler ultrasound methods.
10.3390/bioengineering9090422