Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia
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 (LA...
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| Veröffentlicht in: | Stroke (1970) 2005, Vol.36 (1), p.32-37 |
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| container_title | Stroke (1970) |
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| creator | CHERNYSHEV, Oleg Y GARAMI, Zsolt ALEXANDROV, Andrei V CALLEJA, Sergio SONG, Joon CAMPBELL, Morgan S NOSER, Elizabeth A SHALTONI, Hashem CHEN, Chin-I IGUCHI, Yasuyuki GROTTA, James C |
| description | 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).
NVUE was performed with portable carotid duplex and TCD using standardized fast-track ( or =50% stenoses or thrombus in the symptomatic artery.
One hundred and fifty patients (70 women, mean age 66+/-15 years) underwent NVUE at median 128 minutes after symptom onset. Fifty-four patients (36%) received intravenous or intra-arterial thrombolysis (median National Institutes of Health Stroke Scale (NIHSS) score 14, range 4 to 29; 81% had NIHSS > or =10 points). NVUE demonstrated LAITs in 98% of patients eligible for thrombolysis, 76% of acute stroke patients ineligible for thrombolysis (n=63), and 42% in patients with transient ischemic attack (n=33), P |
| doi_str_mv | 10.1161/01.STR.0000150496.27584.e3 |
| format | Article |
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NVUE was performed with portable carotid duplex and TCD using standardized fast-track (<15 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, > or =50% stenoses or thrombus in the symptomatic artery.
One hundred and fifty patients (70 women, mean age 66+/-15 years) underwent NVUE at median 128 minutes after symptom onset. Fifty-four patients (36%) received intravenous or intra-arterial thrombolysis (median National Institutes of Health Stroke Scale (NIHSS) score 14, range 4 to 29; 81% had NIHSS > or =10 points). NVUE demonstrated LAITs in 98% of patients eligible for thrombolysis, 76% of acute stroke patients ineligible for thrombolysis (n=63), and 42% in patients with transient ischemic attack (n=33), P<0.001. Urgent DSA was performed in 30 patients on average 230 minutes after NVUE. Compared with DSA, NVUE predicted LAIT presence with 100% sensitivity and 100% specificity, although individual accuracy parameters for TCD and carotid duplex specific to occlusion location ranged 75% to 96% because of the presence of tandem lesions and 10% rate of no temporal windows.
Bedside neurovascular ultrasound examination, combining carotid/vertebral duplex with TCD yields a substantial proportion of LAITs in excellent agreement with urgent DSA.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.0000150496.27584.e3</identifier><identifier>PMID: 15569866</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Acute Disease ; Aged ; Angiography, Digital Subtraction ; Biological and medical sciences ; Brain Ischemia - diagnostic imaging ; Carotid Arteries - diagnostic imaging ; Carotid Stenosis - diagnostic imaging ; Female ; Humans ; Intracranial Arterial Diseases - diagnostic imaging ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Nervous system ; Neurology ; Neurosurgery ; Point-of-Care Systems ; Reproducibility of Results ; Skull, brain, vascular surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Ultrasonic investigative techniques ; Ultrasonography, Doppler, Duplex ; Ultrasonography, Doppler, Transcranial ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2005, Vol.36 (1), p.32-37</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c530t-87b9ec3695fbed1ac5cc99790aa38004c98aa76b3fc9a814cbb8b44c8074f4f83</citedby><cites>FETCH-LOGICAL-c530t-87b9ec3695fbed1ac5cc99790aa38004c98aa76b3fc9a814cbb8b44c8074f4f83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,4010,27900,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16392313$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15569866$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>CHERNYSHEV, Oleg Y</creatorcontrib><creatorcontrib>GARAMI, Zsolt</creatorcontrib><creatorcontrib>ALEXANDROV, Andrei V</creatorcontrib><creatorcontrib>CALLEJA, Sergio</creatorcontrib><creatorcontrib>SONG, Joon</creatorcontrib><creatorcontrib>CAMPBELL, Morgan S</creatorcontrib><creatorcontrib>NOSER, Elizabeth A</creatorcontrib><creatorcontrib>SHALTONI, Hashem</creatorcontrib><creatorcontrib>CHEN, Chin-I</creatorcontrib><creatorcontrib>IGUCHI, Yasuyuki</creatorcontrib><creatorcontrib>GROTTA, James C</creatorcontrib><title>Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>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).
NVUE was performed with portable carotid duplex and TCD using standardized fast-track (<15 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, > or =50% stenoses or thrombus in the symptomatic artery.
One hundred and fifty patients (70 women, mean age 66+/-15 years) underwent NVUE at median 128 minutes after symptom onset. Fifty-four patients (36%) received intravenous or intra-arterial thrombolysis (median National Institutes of Health Stroke Scale (NIHSS) score 14, range 4 to 29; 81% had NIHSS > or =10 points). NVUE demonstrated LAITs in 98% of patients eligible for thrombolysis, 76% of acute stroke patients ineligible for thrombolysis (n=63), and 42% in patients with transient ischemic attack (n=33), P<0.001. Urgent DSA was performed in 30 patients on average 230 minutes after NVUE. Compared with DSA, NVUE predicted LAIT presence with 100% sensitivity and 100% specificity, although individual accuracy parameters for TCD and carotid duplex specific to occlusion location ranged 75% to 96% because of the presence of tandem lesions and 10% rate of no temporal windows.
Bedside neurovascular ultrasound examination, combining carotid/vertebral duplex with TCD yields a substantial proportion of LAITs in excellent agreement with urgent DSA.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Angiography, Digital Subtraction</subject><subject>Biological and medical sciences</subject><subject>Brain Ischemia - diagnostic imaging</subject><subject>Carotid Arteries - diagnostic imaging</subject><subject>Carotid Stenosis - diagnostic imaging</subject><subject>Female</subject><subject>Humans</subject><subject>Intracranial Arterial Diseases - diagnostic imaging</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nervous system</subject><subject>Neurology</subject><subject>Neurosurgery</subject><subject>Point-of-Care Systems</subject><subject>Reproducibility of Results</subject><subject>Skull, brain, vascular surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Ultrasonic investigative techniques</subject><subject>Ultrasonography, Doppler, Duplex</subject><subject>Ultrasonography, Doppler, Transcranial</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkV1rFTEQhoMo9rT2L8gi6N1uk83HJt5JsVUoCFovehUms7NtZD9qsnvRf29Oe-BcGpiEgeedvMzL2AfBGyGMuOCi-XX7s-HlCM2VM03baasakq_YTuhW1cq09jXbcS5d3SrnTthpzn8K30qr37ITobVx1pgde7iLNPYVzKUQtwT4VC1DtaV7mtcKlynEmfoKIS1r7C_WBHPGckUYq20sbV62ol0pr3G-r-JcxmwrVUiJQipQzPhAU4R37M0AY6bzw3vGfl99vb38Vt_8uP5--eWmRi35WtsuOEJpnB4C9QJQIzrXOQ4gLecKnQXoTJADOrBCYQg2KIWWd2pQg5Vn7NPL3Me0_N2KLT8VCzSOMNOyZW86qYxw_L9gW5YlpJUF_PwCYlpyTjT4xxQnSE9ecL8PxHPhSyD-GIh_DsTTXvz-8MsWJuqP0kMCBfh4ACAjjEPZLcZ85Ix0ex_yH-YqloE</recordid><startdate>2005</startdate><enddate>2005</enddate><creator>CHERNYSHEV, Oleg Y</creator><creator>GARAMI, Zsolt</creator><creator>ALEXANDROV, Andrei V</creator><creator>CALLEJA, Sergio</creator><creator>SONG, Joon</creator><creator>CAMPBELL, Morgan S</creator><creator>NOSER, Elizabeth A</creator><creator>SHALTONI, Hashem</creator><creator>CHEN, Chin-I</creator><creator>IGUCHI, Yasuyuki</creator><creator>GROTTA, James C</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>2005</creationdate><title>Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia</title><author>CHERNYSHEV, Oleg Y ; GARAMI, Zsolt ; ALEXANDROV, Andrei V ; CALLEJA, Sergio ; SONG, Joon ; CAMPBELL, Morgan S ; NOSER, Elizabeth A ; SHALTONI, Hashem ; CHEN, Chin-I ; IGUCHI, Yasuyuki ; GROTTA, James C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c530t-87b9ec3695fbed1ac5cc99790aa38004c98aa76b3fc9a814cbb8b44c8074f4f83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Angiography, Digital Subtraction</topic><topic>Biological and medical sciences</topic><topic>Brain Ischemia - diagnostic imaging</topic><topic>Carotid Arteries - diagnostic imaging</topic><topic>Carotid Stenosis - diagnostic imaging</topic><topic>Female</topic><topic>Humans</topic><topic>Intracranial Arterial Diseases - diagnostic imaging</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nervous system</topic><topic>Neurology</topic><topic>Neurosurgery</topic><topic>Point-of-Care Systems</topic><topic>Reproducibility of Results</topic><topic>Skull, brain, vascular surgery</topic><topic>Surgery (general aspects). 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Graft diseases</topic><topic>Ultrasonic investigative techniques</topic><topic>Ultrasonography, Doppler, Duplex</topic><topic>Ultrasonography, Doppler, Transcranial</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>CHERNYSHEV, Oleg Y</creatorcontrib><creatorcontrib>GARAMI, Zsolt</creatorcontrib><creatorcontrib>ALEXANDROV, Andrei V</creatorcontrib><creatorcontrib>CALLEJA, Sergio</creatorcontrib><creatorcontrib>SONG, Joon</creatorcontrib><creatorcontrib>CAMPBELL, Morgan S</creatorcontrib><creatorcontrib>NOSER, Elizabeth A</creatorcontrib><creatorcontrib>SHALTONI, Hashem</creatorcontrib><creatorcontrib>CHEN, Chin-I</creatorcontrib><creatorcontrib>IGUCHI, Yasuyuki</creatorcontrib><creatorcontrib>GROTTA, James C</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>CHERNYSHEV, Oleg Y</au><au>GARAMI, Zsolt</au><au>ALEXANDROV, Andrei V</au><au>CALLEJA, Sergio</au><au>SONG, Joon</au><au>CAMPBELL, Morgan S</au><au>NOSER, Elizabeth A</au><au>SHALTONI, Hashem</au><au>CHEN, Chin-I</au><au>IGUCHI, Yasuyuki</au><au>GROTTA, James C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2005</date><risdate>2005</risdate><volume>36</volume><issue>1</issue><spage>32</spage><epage>37</epage><pages>32-37</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>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).
NVUE was performed with portable carotid duplex and TCD using standardized fast-track (<15 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, > or =50% stenoses or thrombus in the symptomatic artery.
One hundred and fifty patients (70 women, mean age 66+/-15 years) underwent NVUE at median 128 minutes after symptom onset. Fifty-four patients (36%) received intravenous or intra-arterial thrombolysis (median National Institutes of Health Stroke Scale (NIHSS) score 14, range 4 to 29; 81% had NIHSS > or =10 points). NVUE demonstrated LAITs in 98% of patients eligible for thrombolysis, 76% of acute stroke patients ineligible for thrombolysis (n=63), and 42% in patients with transient ischemic attack (n=33), P<0.001. Urgent DSA was performed in 30 patients on average 230 minutes after NVUE. Compared with DSA, NVUE predicted LAIT presence with 100% sensitivity and 100% specificity, although individual accuracy parameters for TCD and carotid duplex specific to occlusion location ranged 75% to 96% because of the presence of tandem lesions and 10% rate of no temporal windows.
Bedside neurovascular ultrasound examination, combining carotid/vertebral duplex with TCD yields a substantial proportion of LAITs in excellent agreement with urgent DSA.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>15569866</pmid><doi>10.1161/01.STR.0000150496.27584.e3</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Acute Disease Aged Angiography, Digital Subtraction Biological and medical sciences Brain Ischemia - diagnostic imaging Carotid Arteries - diagnostic imaging Carotid Stenosis - diagnostic imaging Female Humans Intracranial Arterial Diseases - diagnostic imaging Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Nervous system Neurology Neurosurgery Point-of-Care Systems Reproducibility of Results Skull, brain, vascular surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Ultrasonic investigative techniques Ultrasonography, Doppler, Duplex Ultrasonography, Doppler, Transcranial Vascular diseases and vascular malformations of the nervous system |
| title | Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia |
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