Effects of Patient Position on Right-to-Left Shunt Detection by Contrast Transcranial Doppler

Wu, Chuntao; Han, Ke; Guo, Zhen‐Ni; Yang, Yi; Gao, Yongsheng; Bai, Jing; Xing, Yingqi

doi:10.1016/j.ultrasmedbio.2014.09.005

Cited by 10 publications

(7 citation statements)

References 13 publications

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“…Some studies have shown that the upright sitting position is the best position for detecting RLS. 26,27 This was relatively more comfortable and easily achieved.…”

Section: Discussionmentioning

confidence: 98%

“…Second, TCD monitoring was performed in the right lateral decubitus position, although this was not the most optimal position for detecting RLS. 26,27 Therefore, we chose the BA instead of VA and compared it to the MCA in our study. The advantages of using agitated saline while performing the TCD in a suboccipital window (for insonation of the BA) can be explained by several reasons.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous Monitoring of the Middle Cerebral and Basilar Arteries to Detect Right-to-Left Shunts Using Transcranial Doppler by Agitated Saline Administration

Kim

Park

Hong

2021

Preprint

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Transcranial Doppler (TCD) is an easy, non-invasive, and real-time monitoring device for detecting right-to-left shunts (RLS). Nonetheless, it has limited benefits in patients with poor temporal windows. Therefore, we aimed to investigate whether the basilar artery (BA) window was as effective as the middle cerebral artery (MCA) in detecting RLS during TCD monitoring. Overall, we enrolled 344 patients with stroke, transient ischemic attack, headache, or dizziness. MCA and BA were monitored using a modified headset. To investigate the feasibility of the suboccipital window in detecting RLS, we instituted an evaluation tool with three tiers to evaluate microembolic signals (MESs) during TCD monitoring. Tier 1: TCD monitoring of the MCA (bilaterally) in the resting state, tier 2: TCD monitoring of the MCA (bilaterally) while performing the Valsalva maneuver, and tier 3: TCD monitoring of the index MCA and BA while performing the Valsalva maneuver. In tiers 2 and 3, a high agreement rate of 0.8076 and 0.8068 (p<0.001), respectively, on the weighted kappa index, and a high intra-class correlation coefficient of 0.9822 and 0.9860 (p<0.001), respectively, were observed on detecting MESs. Our data suggests that the BA window is as effective as the MCA window for detecting RLS on TCD.

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“…Some studies have shown that the upright sitting position is the best position for detecting RLS. 26,27 This was relatively more comfortable and easily achieved.…”

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Simultaneous Monitoring of the Middle Cerebral and Basilar Arteries to Detect Right-to-Left Shunts Using Transcranial Doppler by Agitated Saline Administration

Kim

Park

Hong

2021

Preprint

View full text Add to dashboard Cite

show abstract

“…In this study, MESs were measured only on the supine position, our method allows us to investigate further patients with prone and sitting postures. Some studies have shown that the upright sitting position is the best position for detecting RLS 40 , 41 . This was relatively more comfortable and easily achieved.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous monitoring of the middle cerebral and basilar arteries to detect right-to-left shunts using transcranial Doppler by agitated saline administration

Kim

Park

Hong

2022

Sci Rep

View full text Add to dashboard Cite

Transcranial Doppler (TCD) is an easy, non-invasive, and real-time monitoring device for detecting right-to-left shunts (RLS). Nonetheless, it has limited benefits in patients with poor temporal windows. Therefore, we aimed to investigate whether the basilar artery (BA) window was as effective as the middle cerebral artery (MCA) in detecting RLS during TCD monitoring. Overall, we enrolled 344 patients with stroke, transient ischemic attack, headache, or dizziness. MCA and BA were monitored using a modified headset. To investigate the feasibility of the suboccipital window in detecting RLS, we instituted an evaluation tool with three tiers to evaluate microembolic signals (MESs) during TCD monitoring. Tier 1: TCD monitoring of the MCA (bilaterally) in the resting state, tier 2: TCD monitoring of the MCA (bilaterally) while performing the Valsalva maneuver, and tier 3: TCD monitoring of the index MCA and BA while performing the Valsalva maneuver. In tiers 2 and 3, a high agreement rate of 0.808 and 0.809 (p < 0.001), respectively, on the weighted kappa index, and a high intra-class correlation coefficient of 0.982 and 0.986 (p < 0.001), respectively, were observed on detecting MESs. Our data suggests that the BA window is as effective as the MCA window for detecting RLS on TCD.

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“…The criterion of a “valid procedure” is that the spectrum of the M-mode remains stable. Secondly, the right lateral decubitus was not the optimal position for RLS detection, due to the anatomic location of the right atrium and patent foreman ovale, which may have affected the performance of the standard VM 18 19 20 21 . However, MCA and VA monitoring were performed simultaneously in the same position, even if the positive rate of RLS detection may be a little lower than that in other positions; however, the comparison between MCA and VA monitoring was not affected.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Vertebral Artery and Middle Cerebral Artery Monitoring for Right-to-left Shunt Detection by Contrast-enhanced Transcranial Doppler

Guo

Gao

Guo

et al. 2016

Sci Rep

Self Cite

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Contrast-enhanced transcranial Doppler (c-TCD) is a reliable and reproducible method for right-to-left shunt (RLS) detection, with high sensitivity. Monitoring the middle cerebral artery (MCA) is an optimal choice, yet for patients with insufficient temporal bone windows or severe stenosis of carotid arteries, an alternative should be established. The aim of the present study was to further establish whether c-TCD with vertebral artery (VA) monitoring is as effective as MCA monitoring for RLS detection. We evaluated 194 subjects for RLS detection with VA and MCA monitoring simultaneously. There was no significant difference between the positive rates of VA and MCA monitoring for RLS detection. c-TCD with VA monitoring could be an alternative for RLS detection, with high sensitivity and specificity both at rest and during the Valsalva manoeuvre.

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Effects of Patient Position on Right-to-Left Shunt Detection by Contrast Transcranial Doppler

Cited by 10 publications

References 13 publications

Simultaneous Monitoring of the Middle Cerebral and Basilar Arteries to Detect Right-to-Left Shunts Using Transcranial Doppler by Agitated Saline Administration

Simultaneous Monitoring of the Middle Cerebral and Basilar Arteries to Detect Right-to-Left Shunts Using Transcranial Doppler by Agitated Saline Administration

Simultaneous monitoring of the middle cerebral and basilar arteries to detect right-to-left shunts using transcranial Doppler by agitated saline administration

Comparison of Vertebral Artery and Middle Cerebral Artery Monitoring for Right-to-left Shunt Detection by Contrast-enhanced Transcranial Doppler

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