Consensus Recommendations for Transcranial Color-Coded Duplex Sonography for the Assessment of Intracranial Arteries in Clinical Trials on Acute Stroke

Nedelmann, Max; Stolz, Erwin; Gerriets, Tibo; Baumgartner, Ralf W.; Malferrari, Giovanni; Seidel, Guenter; Kaps, Manfred

doi:10.1161/strokeaha.109.555169

Cited by 138 publications

(117 citation statements)

References 65 publications

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“…It provides functional and prognostic information valuable for individual patient management (Allendoerfer et al, 2006;Nedelmann et al, 2009;Perren et al, 2006;Wunderlich et al, 2007). Next to diagnostic applications, randomized clinical studies suggest therapeutic efficacy of ultrasound on recanalization of acute cerebral artery occlusion in terms of an acceleration of fibrinolysis with recombinant tissue-type plasminogen activator (rt-PA) (Alexandrov et al, 2004;Eggers et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Nedelmann

Ritschel

Doenges

et al. 2010

J Cereb Blood Flow Metab

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In monitoring of recanalization and in sonothrombolysis, contrast-enhanced ultrasound (CEUS) is applied in extended time protocols. As extended use may increase the probability of unwanted effects, careful safety evaluation is required. We investigated the safety profile and beneficial effects of CEUS in a reperfusion model. Wistar rats were subjected to filament occlusion of the right middle cerebral artery (MCA). Reperfusion was established after 90 minutes, followed by recombinant tissue-type plasminogen activator (rt-PA) treatment and randomization to additional CEUS (contrast agent: SonoVue; 60 minutes). Blinded outcome evaluation consisted of magnetic resonance imaging (MRI), neurologic assessment, and histology and, in separate experiments, quantitative 3D nano-computed tomography (CT) angiography (900 nm 3 voxel size). Nano-CT revealed severely compromised microcirculation in untreated animals after MCA reperfusion. The rt-PA partially improved hemispheric perfusion. Impairment was completely reversed in animals receiving rt-PA and CEUS. This combination was more effective than treatment with either CEUS without rt-PA or rt-PA and ultrasound or ultrasound alone. In MRI experiments, CEUS and rt-PA treatment resulted in a significantly reduced ischemic lesion volume and edema formation. No unwanted effects were detected on MRI, histology, and intracranial temperature assessment. This study shows that CEUS and rt-PA is safe in the situation of reperfusion and displays beneficial effects on the level of the microvasculature.

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Section: Introductionmentioning

confidence: 99%

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Nedelmann

Ritschel

Doenges

et al. 2010

J Cereb Blood Flow Metab

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“…Specific descriptions of ultrasound technology and scanning protocols can be found elsewhere [42,43].…”

Section: Transcranial Doppler and Transcranial Duplexmentioning

confidence: 99%

Vascular Imaging in Stroke: Comparative Analysis

Barlinn

Alexandrov

2011

Neurotherapeutics

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Advances in stroke treatment have mirrored advances in vascular imaging. Understanding and advances in reperfusion therapies were made possible by improvements in computed tomographic angiography, magnetic resonance angiography, neurovascular ultrasound, and renewed interest in catheter angiography. As technology allows better noninvasive vascular diagnosis, digital subtraction angiography (the remaining gold standard for vascular imaging) is increasingly used for rescue procedures and elective interventions. This review will examine specific advantages and disadvantages of different vascular imaging modalities as related to stroke diagnosis.

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“…The advantages of TCCS compared to TCD in the acute setting are the use of M-mode and color-coded evaluation, been more reliably to identify blood flow in a specific intracranial vessel segment with more detailed allocation of vessel pathology and more accurate measurements of the flow velocity. Additionally, TCCS detects the position of the third ventricle and a potential midline shift in the IS 10 . The use of contrast-enhanced TCCS was better than TCD and TCCS in the acute IS setting 7 .…”

Section: Discussionmentioning

confidence: 99%

The use of neurovascular ultrasound versus digital subtraction angiography in acute ischemic stroke

Lange

Bruch

Pedrozo

et al. 2015

Arq. Neuro-Psiquiatr.

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Cervical and intracranial arterial evaluation is an important issue for acute ischemic stroke (IS). Objective: Compare the use of the neurovascular ultrasound examination (NVUE) to digital subtraction angiography (DSA) in acute IS patients for diagnosing significant extracranial and intracranial arteriopathy. Method: Nonconsecutive patients with IS or transient ischemic attack admitted within 12 hours of the onset of symptoms were evaluated retrospectively. Standardized NVUE and DSA were done in all patients within the first 120 hours of hospital admission. Results: Twenty-four patients were included in the study. Compared to DSA, the NVUE demonstrated 94.7% sensitivity and 100% specificity for identifying symptomatic extracranial and/or intracranial arteriopathy. Conclusion: The standardized NVUE technique demonstrated high sensitivity and specificity compared to DSA for diagnosing arterial abnormalities in acute IS patients.Keywords: transcranial Doppler, ultrasonography, digital substraction angiography, ischemic stroke. RESUMOA avaliação cervical e intracraniana é uma etapa importante no AVC isquêmico (AVCi) agudo. Objetivo: Comparar o uso do ultrassom neurovascular (USNV) com técnica padronizada e a angiografia digital (AD) em paciente com AVCi agudo no diagnóstico de doença arterial significativa extra e/ou intracraniana. Método: Pacientes com AVCi e AIT admitidos em até 12 horas do início dos sintomas foram retrospectivamente avaliados. Todos os pacientes foram submetidos a USNV e AD padronizado em até 120 horas da admissão. Resultados: Vinte e quatro pacientes foram incluídos no estudo. Em comparação com a AD, o USNV apresentou sensibilidade de 94,7% e especificidade de 100% para o diagnóstico de doença arterial significativa extra e/ou intracraniana. Conclusão: O uso de técnica padronizada de USNV demonstrou elevada sensibilidade e especificidade para o diagnóstico de doença arterial significativa extra e intracraniana quando comparado a AD.Palavras-chave: ultrassom diagnóstico, ultrassom, angiografia, acidente vascular cerebral isquêmico.

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Consensus Recommendations for Transcranial Color-Coded Duplex Sonography for the Assessment of Intracranial Arteries in Clinical Trials on Acute Stroke

Cited by 138 publications

References 65 publications

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Vascular Imaging in Stroke: Comparative Analysis

The use of neurovascular ultrasound versus digital subtraction angiography in acute ischemic stroke

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