Intracranial Vessel Localization with Power Motion Doppler (PMD-TCD) Compared with CT Angiography in Patients with Acute Ischaemic Stroke

Barlinn, Kristian; Živanović, Željko; Zhao, Limin; Kesani, Maruthi; Balucani, Clotilde; Tsivgoulis, Georgios; Alexandrov, Andrei V.

doi:10.1111/j.1747-4949.2011.00751.x

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…[25][26][27] Other promising strategies that could help prehospital identification of stroke patients with LAO include serum biomarkers aiming to differentiate AIS and intracerebral hemorrhage 28,29 and automated or telemedicine-guided transcranial ultrasound imaging. 30,31 Our study has several limitations. First, our population does not represent patients with suspected stroke examined in the prehospital setting but those admitted to a CSC.…”

Section: Discussionmentioning

confidence: 99%

“…FNR represents the proportion of patients who would not have been sent to a CSC despite LAO, hence delaying optimal treatment, and FPR represents the proportion of patients who would have been sent to a CSC despite lack of LAO (futile transfers). The highest accuracy (79%; 95% confidence interval, 77-82) was observed for NIHSS score ≥11 (FNR, 27% [22][23][24][25][26][27][28][29][30][31][32]; FPR, 17% [14][15][16][17][18][19][20]), NIHSS score ≥14 (FNR, 39% [34][35][36][37][38][39][40][41][42][43][44]; FPR, 12% [9][10][11][12][13][14]), and RACE score ≥5 (FNR, 33% [28][29][30][31][32][33][34][35][36][37][38]; FPR, 15% [12][13][14]…”

Section: Resultsmentioning

confidence: 99%

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Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion

Turc

Maïer

Naggara

et al. 2016

Stroke

162

138

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Background and Purpose-It remains debated whether clinical scores can help identify acute ischemic stroke patients with large-artery occlusion and hence improve triage in the era of thrombectomy. We aimed to determine the accuracy of published clinical scores to predict large-artery occlusion. Methods-We assessed the performance of 13 clinical scores to predict large-artery occlusion in consecutive patients with acute ischemic stroke undergoing clinical examination and magnetic resonance or computed tomographic angiography ≤6 hours of symptom onset. When no cutoff was published, we used the cutoff maximizing the sum of sensitivity and specificity in our cohort. We also determined, for each score, the cutoff associated with a false-negative rate ≤10%. Results-Of 1004 patients (median National Institute of Health Stroke Scale score, 7; range, 0-40), 328 (32.7%) had an occlusion of the internal carotid artery, M1 segment of the middle cerebral artery, or basilar artery. The highest accuracy (79%; 95% confidence interval, 77-82) was observed for National Institute of Health Stroke Scale score ≥11 and Rapid Arterial Occlusion Evaluation Scale score ≥5. However, these cutoffs were associated with false-negative rates >25%. Cutoffs associated with an false-negative rate ≤10% were 5, 1, and 0 for National Institute of Health Stroke Scale, Rapid Arterial Occlusion Evaluation Scale, and Cincinnati Prehospital Stroke Severity Scale, respectively. Conclusions-Using published cutoffs for triage would result in a loss of opportunity for ≥20% of patients with large-artery occlusion who would be inappropriately sent to a center lacking neurointerventional facilities. Conversely, using cutoffs reducing the false-negative rate to 10% would result in sending almost every patient to a comprehensive stroke center. Our findings, therefore, suggest that intracranial arterial imaging should be performed in all patients with acute ischemic stroke presenting within 6 hours of symptom onset.

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Section: Discussionmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion

Turc

Maïer

Naggara

et al. 2016

Stroke

162

138

View full text Add to dashboard Cite

show abstract

“…Our model was built on known changes in ultrasound energy levels in the skin, fat, muscle, bone, and brain tissues along the path of the longitudinal pulse wave traveling from the transducer to detect residual flow signals in acutely obstructed intracranial vessels. [15][16][17][18][19][20][21][22][23][24] The acoustic model was built for the temporal bone window because all occlusions were monitored through this acoustic window using a standard FDA-approved head frame for TCD equipment (Multigon, Yonkers, NY). The model was applied retrospectively by observers blinded to recanalization and outcomes, after completion of the trial.…”

Section: Methodsmentioning

confidence: 99%

Exploratory analysis of estimated acoustic peak rarefaction pressure, recanalization, and outcome in the transcranial ultrasound in clinical sonothrombolysis trial

Barlinn

Tsivgoulis

Molina

et al. 2012

J of Clinical Ultrasound

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“…66 Since these studies were published, progress has been made in transcranial Doppler imaging, which now shows good agreement with CTA as demonstrated for intracranial vessel localization. 67 Transcranial power Doppler ultrasonography could, therefore, be re-evaluated for intracranial aneurysm imaging.…”

Section: Transcranial Power Doppler Ultrasonographymentioning

confidence: 99%

Intracranial Aneurysms: Wall Motion Analysis for Prediction of Rupture

Vanrossomme

Thiran

Courbebaisse

et al. 2015

AJNR Am J Neuroradiol

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SUMMARY:Intracranial aneurysms are a common pathologic condition with a potential severe complication: rupture. Effective treatment options exist, neurosurgical clipping and endovascular techniques, but guidelines for treatment are unclear and focus mainly on patient age, aneurysm size, and localization. New criteria to define the risk of rupture are needed to refine these guidelines. One potential candidate is aneurysm wall motion, known to be associated with rupture but difficult to detect and quantify. We review what is known about the association between aneurysm wall motion and rupture, which structural changes may explain wall motion patterns, and available imaging techniques able to analyze wall motion.

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Intracranial Vessel Localization with Power Motion Doppler (PMD-TCD) Compared with CT Angiography in Patients with Acute Ischaemic Stroke

Abstract: Power motion transcranial Doppler intercepts proximal vessels with good-to-excellent agreement with computed tomography angiography. Depth ranges (as opposed to average depths) can be used to target intracranial arterial segments for sonothrombolysis.

Cited by 6 publications

References 18 publications

Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion

Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion

Exploratory analysis of estimated acoustic peak rarefaction pressure, recanalization, and outcome in the transcranial ultrasound in clinical sonothrombolysis trial

Intracranial Aneurysms: Wall Motion Analysis for Prediction of Rupture

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