Yield and Accuracy of Urgent Combined Carotid/Transcranial Ultrasound Testing in Acute Cerebral Ischemia

Abstract

Background and Purpose-We routinely perform an urgent bedside neurovascular ultrasound examination (NVUE) with carotid/vertebral duplex and transcranial Doppler (TCD) in patients with acute cerebral ischemia. We aimed to determine the yield and accuracy of NVUE to identify lesions amenable for interventional treatment (LAITs). Methods-NVUE was performed with portable carotid duplex and TCD using standardized fast-track (Ͻ15 minutes) insonation protocols. Digital subtraction angiography (DSA) was the gold standard for identifying LAIT. These lesions were defined as proximal intra-or extracranial occlusions, near-occlusions, Ն50% stenoses or thrombus in the symptomatic artery.

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

“…All patients underwent a standardized NVUE looking for any extracranial or intracranial abnormalities based on a fast-track neurovascular ultrasound examination (15 minutes) 1 . In patients submitted to thrombolytic therapy, the NVUE was performed more than 3 hours after the treatment.…”

“…Intracranial abnormalities were identified when an increased segmental flow velocity associated with retrograde flow, vessel occlusion signals or turbulent flow patterns were observed based on a fast-track neurovascular ultrasound examination 1 . The flow velocity measurements in the intracranial evaluation were not corrected according to the incident angle 1,9,10,11 .…”

“…The neurovascular ultrasound examination (NVUE), carotid and vertebral duplex (CVD) and transcranial Doppler (TCD), is an important tool for identifying the etiology of ischemic stroke (IS) 1 . Previous studies demonstrated that the compromise of the extracranial and main intracranial arteries could increase the risk of recurrence of IS compared to other stroke mechanisms, even after a transient ischemic attack (TIA) 2,3 .…”

“…The NVUE is a non-invasive and bedside evaluation performed in an acute IS setting as a fast-track procedure, spending less than 15 minutes 1 . In addition, the TCD methodology helps identify microembolism secondary to heart disease and proximal cervical arteries, evaluate recanalization and even increase the effect of thrombolytic therapy 4 .…”

Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke

“…Transcranial Doppler (TCD) has been shown to have good accuracy for detecting PAO and might be useful in patients with AIS who have contraindications to CTA and MRA 25,26 . However, this method was not systematically used to select patients in a clinical trial of endovascular treatment, and its use in the AIS setting demands a high level of expertise.…”