Abstract WP237: Novel Probe Attached to the Cervix Can Evaluate Right-to-left Shunt More Precisely Than Transcranial Doppler

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hidetaka Mitsumura ◽  
Ayumi Arai ◽  
Teppei Komatsu ◽  
Kenichi Sakuta ◽  
Kenichiro Sakai ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Temporal Bone ◽  
Cerebral Artery ◽  
Transcranial Doppler ◽  
Common Carotid Artery ◽  
Valsalva Maneuver ◽  
Center Frequency ◽  
Bone Window ◽  
The Right

Introduction: While the examination for the evaluation of right-to-left shunt (RLS) using contrast transcranial Doppler (TCD) is useful, insufficient temporal bone window interrupts the adequate TCD examination for precise diagnosis of RLS. Thus, we developed a novel probe (paste-able soft ultrasound probe; PSUP) attached to the cervix for RLS diagnosis. Hypothesis: Monitoring at carotid artery using PSUP can detect greater number of contrast microembolic signals (cMES) than that of TCD. Methods: Subjects were patients with ischemic stroke or transient ischemic attack who had one and more cMES in middle cerebral artery detected by screening test of TCD on admission. PSUP was a 2.0-MHz center frequency and had an equal property with TCD transducer. The shape was thin, soft, and square modified for adequate attachment to the neck. We monitored blood flow of unilateral middle cerebral artery by TCD and ipsilateral common carotid artery by PSUP simultaneously. After injection of saline agitated with air in the right antecubital vein, we performed single test without Valsalva maneuver (VM) and triple tests with VM. And then, we compared the number of cMES between PSUP and TCD among each patient. Results: We performed 48 simultaneous PSUP and TCD examination (12 studies without VM, and 36 studies with VM) on 12 patients (11 male, median age of 49 years) without any complication. The number of cMES on PSUP was significantly larger than that of TCD in all of 48 examination (345 vs. 206, p<0.001), in 12 studies without VM (72 vs. 37, p=0.017), and in 36 studies with VM (273 vs. 169, p<0.001). Conclusions: In order to evaluate the RLS, PSUP examination at common carotid artery is a powerful approach in comparison with TCD. For patients without sufficient temporal bone window, PSUP should play an important role of RLS diagnosis.

Abstract TP221: A Novel Ultrasound Probe Attached to the Cervix Can Precisely Detect Large Patent Foramen Ovale

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hidetaka Mitsumura ◽  
Ayumi Arai ◽  
Kenichi Sakuta ◽  
Kenichiro Sakai ◽  
Yuka Terasawa ◽  
...  
Keyword(s):  
Temporal Bone ◽  
Patent Foramen Ovale ◽  
Valsalva Maneuver ◽  
Interatrial Septum ◽  
Center Frequency ◽  
Foramen Ovale ◽  
Ultrasound Probe ◽  
Diagnostic Ability ◽  
Bone Window ◽  
The Right

Introduction: We developed a novel probe (paste-able soft ultrasound probe; PSUP) attached to the cervix for detection of right-to-left shunt (RLS), because insufficient temporal bone window interrupts the precise examination for diagnosis of RLS. Hypothesis: We assessed the hypothesis that diagnostic ability of PSUP for RLS detection is equal to those of transesophageal echocardiography (TEE). Methods: Subjects were patients with ischemic stroke and transient ischemic attack who underwent TEE. PSUP was a 2.0-MHz center frequency, which had an equal property with TCD, and the shape was thin, soft, and square modified for attachment to the neck. At first, we performed TEE with the echoscope at the level of the fossa ovalis after injection of saline agitated with air in the right antecubital vein. The procedure was performed with and without Valsalva maneuver. Visualization of microembolic signals (MES) induced contrast agent within the right atrium and crossing the interatrial septum was considered as positive patent foramen ovale (PFO). We divided PFO into two groups according to number of MES, such as small PFO (1-29 of MES) and large PFO (≥30 of MES). Then, monitoring using PSUP was performed at unilateral common carotid artery (CCA) using similar preparation and procedure to TEE. RLS by PSUP diagnosed when we found 1and more MES in CCA. We compared detectable rate by size of PFO between TEE and PSUP, and calculated accuracy of PSUP against TEE. Results: From May 2014 to July 2015, 62 patients (46 male, mean age of 61 years) were included in this study. We diagnosed 26 of 62 patients (42%) as PFO by TEE, whereas PSUP detected in 17 of them (27%). As a reference of TEE findings, diagnostic ability of PSUP was 58% of sensitivity, 94% of specificity, and 79% of accuracy. In TEE examination, large PFO was 11 patients and small was 15 patients. PSUP could evaluate large PFO (9 of 11 patients) more accurately than small one (6 of 15, 82% vs. 40%, p=0.05). Conclusion: PSUP should have a considerable accuracy of large PFO diagnosis. For patients with insufficient temporal bone window, PSUP may play an important role of detecting large PFO.

CHANGES IN BLOOD FLOW OF COMMON CAROTID ARTERY AND MIDDLE CEREBRAL ARTERY DURING EXERCISE

1999 ◽  
Vol 31 (Supplement) ◽  
pp. S194
Author(s):  
N. Murase ◽  
T. Katsumura ◽  
T. Osada ◽  
T. Hamaoka ◽  
Y. Yamamoto ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Common Carotid Artery

scholarly journals Percutaneous Angioplasty of the Sole Patent Cerebral Artery in Two Patients with Takayasu's Aortoarteritis

2016 ◽  
Vol 10 ◽  
pp. CMC.S38329
Author(s):  
Kiron Varghese ◽  
Srilakshmi M. Adhyapak
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Balloon Angioplasty ◽  
Common Carotid Artery ◽  
Critical Stenosis ◽  
Neurological Event ◽  
Protection Devices ◽  
Distal Protection ◽  
The Right

We report two female patients with Takayasu's aortoarteritis, who presented with symptoms of cerebral ischemia due to critical stenosis of the sole patent cerebral artery. Both had occlusion of both vertebral arteries and one carotid artery with critical stenosis of the other carotid artery and presented with hemiparesis contralateral to the patent but stenosed cerebral artery. They also had transient ischemic attacks attributable to the culprit vessel. In the first patient, balloon angioplasty alone was not successful, and hence, a self-expanding stent was deployed in the right common carotid artery. In the second patient, successful balloon angioplasty was performed for the left common carotid artery. Distal protection devices were not used, and neither patient experienced any periprocedural neurological event. Clinical follow-up at six months revealed no significant cerebral events.

Combined endovascular and surgical treatment of symptomatic tandem occlusion of common carotid artery and middle cerebral artery – case report

2019 ◽  
Vol 98 (6) ◽  
pp. 252-255
Keyword(s):  
Case Report ◽  
Cerebral Ischemia ◽  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Common Carotid Artery ◽  
Neurologic Deficit ◽  
Cerebrovascular Event ◽  
Tandem Occlusion ◽  
Acute Cerebral Ischemia

Introduction: Cerebrovascular events are among the most common causes of invalidity or death. The aim of treatment in acute cerebral ischemia is to restore the blood flow before irreversible necrosis of brain tissue and persistent neurologic deficit occur. Pharmacological, endovascular and surgical methods are employed in the treatment of these patients. Case report: The authors present a case report of a 56-year-old woman with acute cerebral ischemia caused by tandem occlusion of the left com- mon carotid artery and the M1 segment of middle cerebral artery. In the initial phase the patient was treated by intravenous thrombolysis with minimal success. Common carotid artery was occluded and mechanical extraction of embolus was successfully performed through direct carotid bifurcation puncture. Almost complete regression of neurologic deficit occurred after the endovascular recanalization. Occluded common carotid stump and bifurcation was considered as a source of embolization and therefore, to prevent further cerebrovascular event, a subclavian-carotid bypass was performed on the 15th day after the stroke. Conclusion: In the reported patient with symptomatic tandem occlusion of common carotid artery and the M1 part of middle cerebral artery, recanalization of cerebral artery was attained by the combination of pharmacological and endovascular method. Consequent subclavian-to-carotid bypass was performed in tertiary prevention of further cerebrovascular event.

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