No abstract

Background and Purpose-Transcranial Doppler (TCD) and carotid duplex (CD) provide rapid and safe screening for stroke patients but are highly operator dependent. We explored the feasibility of telemedicine (TM)-guided TCD/CD administered by a health care provider inexperienced with ultrasound. Methods-Dual video screens transmitted real-time TCD/CD images and sound to a neurosonographer. TM TCD/CD characteristics were compared with an in-person (IP) examination independently obtained on the same patient. We compared carotid stenosis, thrombolysis in brain ischemia (TIBI) flow grades, and the time spent on testing. Results-We examined 8 subjects with a median age of 51 (31 to 63 range). IP and TM successfully examined 100% of internal carotid and middle cerebral arteries, 50% versus 44% of anterior cerebral artery, and 100% versus 88% of the basilar arteries, respectively. The median time in minutes IP versus TM was 15 (range 10 to 35) and 30 (15 to 50) for CD (Pϭ0.07) and 18 (15 to 30) and 45 (30 to 55) for TCD (Pϭ0.002), respectively. TM correctly identified all normal CD/TCD examinations in 7 subjects. In 1 patient, TM identified carotid occlusion but misread TIBI flow grades in both middle cerebral arteries. Conclusions-Our pilot study showed the feasibility of TCD/CD by an inexperienced health professional guided by a sonographer via TM. Tests were completed within times comparable to outpatient setting in a vascular laboratory. Key Words: Doppler, transcranial Ⅲ stroke Ⅲ telemedicine Ⅲ ultrasonography T elemedicine technology is used to provide immediate and remote expert assessment in treatment decisionmaking. 1,2 Several studies have reported the feasibility and reliability of remote stroke consultation such as the assessment of the National Institutes of Health Stroke Scale 3,4 and treatment with intravenous thrombolysis. 5 Neurovascular examination with portable carotid duplex (CD) and transcranial Doppler (TCD), compared with computed tomography and magnetic resonance angiography, offer rapid, inexpensive, noninvasive bedside screening of patients and identification of vessel occlusions amenable for interventional treatment. 6,7 Moreover, continuous TCD monitoring with systemic thrombolysis may improve early recanalization 8 and identify candidates for bridging into intra-arterial treatment. 9 Neurosonographers are not readily available around the clock in emergency rooms nationwide. Therefore, we performed a pilot study to assess the feasibility of neurovascular testing by a health care provider inexperienced with ultrasound, guided via telemedicine (TM), by an expert sonographer. Subjects and MethodsFour experienced neurosonographers (stroke neurologists with registered vascular technologist certification or -eligible with Ͼ8 years of ultrasound practice) and 3 healthcare providers, novice to ultrasound (a stroke nurse, a neurologist, and an ophthalmologist without formal theoretical and hands-on training in ultrasound nor familiarity with operating ultrasound machines) participated in the study. All...