scholarly journals Assessment of intracranial venous blood flow after subarachnoid hemorrhage: a new approach to diagnose vasospasm with transcranial color-coded duplex sonography

2018 ◽  
Vol 129 (5) ◽  
pp. 1136-1142 ◽  
Author(s):  
Florian Connolly ◽  
Stephan J. Schreiber ◽  
Christoph Leithner ◽  
Georg Bohner ◽  
Peter Vajkoczy ◽  
...  
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Peak Systolic Velocity ◽  
Duplex Sonography ◽  
Venous Blood Flow ◽  
Additional Advantage ◽  
Basal Vein Of Rosenthal ◽  
Color Coded Duplex Sonography

OBJECTIVETranscranial color-coded duplex sonography (TCCS) is a reliable tool that is used to assess vasospasm in the M1 segment of the middle cerebral artery (MCA) after subarachnoid hemorrhage (SAH). A distinct increase in blood flow velocity (BFV) is the principal criterion for vasospasm. The MCA/internal carotid artery (ICA) index (Lindegaard Index) is also widely used to distinguish between vasospasm and cerebral hyperperfusion. However, extracranial ultrasonography assessment of the neck vessels might be difficult in an intensive care unit. Therefore, the authors evaluated whether the relationship of intracranial arterial to venous BFV might indicate vasospasm with similar or even better accuracy.METHODSPatients who presented between 2008 and 2015 with aneurysmal SAH were prospectively enrolled in the study. Digital subtraction angiography (DSA) and TCCS were performed within 24 hours of each other to assess vasospasm 8–10 days after SAH. The following different TCCS parameters were analyzed to assess vasospasm in the MCA and were compared with the gold-standard DSA parameters: 1) mean time-averaged maximum BFV (Vmean) of the MCA, 2) peak systolic velocity (PSV) of the MCA, 3) the Lindegaard Index using Vmean as well as PSV, and 4) a new arteriovenous index (AVI) between the MCA and the basal vein of Rosenthal using Vmean and PSV. The best cutoff values for these parameters to distinguish vasospasm from normal perfusion or hyperperfusion were calculated using receiver operating characteristic curve analysis. Sensitivity, specificity, positive predictive value, and negative predictive value as well as the overall accuracy for each cutoff value were analyzed.RESULTSA total of 102 patients (mean age 52 ± 12 years) were evaluated. Bilateral MCA assessment by TCCS was successful in all patients. In 6 cases (3%), the BFV of the basal vein of Rosenthal could not be analyzed. The AVI could not be calculated in 50 of 204 cases (25%) because the insonation quality was very low in one of the ICAs. An AVI > 10 for Vmean and an AVI > 12 for systolic velocity provided the highest accuracies of 87% and 86%, respectively. Regarding the Lindegaard Index, the accuracy was highest using a threshold of > 3 for the mean BFV (84%) as well as systolic BFV (80%). BFVs in the MCA of ≥ 120 cm/sec (Vmean) and ≥ 200 cm/sec (PSV) predicted vasospasm with accuracies of 84% and 83%, respectively. A combined analysis of the MCA BFV and the AVI led to a slight increase in specificity (Vmean, 94%; PSV, 93%) and positive predictive value (Vmean, 88%; PSV 86%) without further improvement in accuracy (Vmean, 88%; PSV, 84%).CONCLUSIONSThe intracranial AVI is a reliable parameter that can be used to assess vasospasm after SAH. Its reliability for differentiating vasospasm and hyperperfusion is slightly higher than that for the established Lindegaard Index, and this method has the additional advantage of a remarkably lower failure rate.

TRANSCRANIAL DOPPLER FOR PREDICTING DELAYED CEREBRAL ISCHEMIA AFTER SUBARACHNOID HEMORRHAGE

Neurosurgery ◽  
2009 ◽  
Vol 65 (2) ◽  
pp. 316-324 ◽  
Author(s):  
Emmanuel Carrera ◽  
J. Michael Schmidt ◽  
Mauro Oddo ◽  
Luis Fernandez ◽  
Jan Claassen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Positive Predictive Value ◽  
Transcranial Doppler ◽  
Predictive Value ◽  
Delayed Cerebral Ischemia ◽  
Clinical Deterioration ◽  
Computed Tomographic ◽  
Study Team ◽  
Maximal Sensitivity

Abstract OBJECTIVE Transcranial Doppler (TCD) is widely used to monitor the temporal course of vasospasm after subarachnoid hemorrhage (SAH), but its ability to predict clinical deterioration or infarction from delayed cerebral ischemia (DCI) remains controversial. We sought to determine the prognostic utility of serial TCD examination after SAH. METHODS We analyzed 1877 TCD examinations in 441 aneurysmal SAH patients within 14 days of onset. The highest mean blood flow velocity (mBFV) value in any vessel before DCI onset was recorded. DCI was defined as clinical deterioration or computed tomographic evidence of infarction caused by vasospasm, with adjudication by consensus of the study team. Logistic regression was used to calculate adjusted odds ratios for DCI risk after controlling for other risk factors. RESULTS DCI occurred in 21% of patients (n = 92). Multivariate predictors of DCI included modified Fisher computed tomographic score (P = 0.001), poor clinical grade (P = 0.04), and female sex (P = 0.008). After controlling for these variables, all TCD mBFV thresholds between 120 and 180 cm/s added a modest degree of incremental predictive value for DCI at nearly all time points, with maximal sensitivity by SAH day 8. However, the sensitivity of any mBFV more than 120 cm/s for subsequent DCI was only 63%, with a positive predictive value of 22% among patients with Hunt and Hess grades I to III and 36% in patients with Hunt and Hess grades IV and V. Positive predictive value was only slightly higher if mBFV exceeded 180 cm/s. CONCLUSION Increased TCD flow velocities imply only a mild incremental risk of DCI after SAH, with maximal sensitivity by day 8. Nearly 40% of patients with DCI never attained an mBFV more than 120 cm/s during the course of monitoring. Given the poor overall sensitivity of TCD, improved methods for identifying patients at high risk for DCI after SAH are needed.

Assessment of the penile vascular system with color-coded duplex sonography and pharmacocavernosometry and -graphy in impotent men

1997 ◽  
Vol 38 (2) ◽  
pp. 303-308 ◽  
Author(s):  
R. Andresen ◽  
H. E. H. Wegner
Keyword(s):  
Blood Flow ◽  
Flow Velocity ◽  
Peak Flow ◽  
Venous Drainage ◽  
Duplex Sonography ◽  
Normal Value ◽  
Diastolic Flow ◽  
Peak Flow Velocity ◽  
Color Coded Duplex Sonography ◽  
Venous Leakage

Objective: to examine the extent to which color-coded duplex sonography permits complete clarification of vessel-dependent erectile dysfunction (ED). Material and Methods: A total of 215 patients with ED were examined All patients underwent pharmacocolor-coded duplex sonography (PHCCDS; 20 μg of prostaglan-din El, PGE1, intracavernosally) as well as pharmacocavernosometry and -graphy (PHCM and PHCG; 20 μg of PGEl intracavernosally). the penile vessels were visualized, i.e. the dorsal arteries, the cavernosal arteries, and the anastomoses between them, as well as the venous pathways. Peak flow and end-diastolic flow in all arteries and, when present, anastomoses were determined after stimulation. Induction flow to achieve maximal tumescence/rigidity as well as maintenance flow were determined during PHCM. Finally, for the morphological visualization of the cavernous body and possible venous insufficiencies, a radiography in 2 planes was produced with infusion of a water-soluble contrast medium. Results: in 145 patients with a grade 0-III tumescence after stimulation with 20 μg of PGEI, PHCCDS revealed an end-diastolic flow of >5 cm/s, with a peak flow velocity >25 cm/s in the 2 cavernosal and 2 dorsal arteries. the deep dorsal vein of the penis was visualized in 110 of these 145 patients with a blood flow >5 cm/s, and in 35 cases with a blood flow <5 cm/s. Venous drainage to the corpus spongiosum was visualized in 80 patients with a blood flow >10 cm/s. All patients had a pathologically increased induction (normal value <100 ml/min) and maintenance venous flow (normal value <10 ml/min) in the PHCM as well as venous drainage in the PHCG. Sixty patients with a tumescence grade of IV-V (rigidity) had a peak flow velocity clearly >25 cm/s, an end-diastolic flow <5 cm/s in the 2 cavernosal and 2 dorsal arteries in the PHCCDS, as well as induction values <100 ml/min and maintenance flow values <10 ml/min in the PHCM, without visible insufficient efferent venous pathways on the PHCG. in 29 patients (13.5%) hemodynamically active anastomoses perforating the tunica albuginea could be detected. Ten patients with a tumescence grade of III had a peak flow velocity <25 cm/s and an end-diastolic flow <5 cm/s without venous leakage in PHCM and PHCG. Conclusion: PHCCDS allows for the assessment of arterial flow disorder as well as of venous leakage in ED. PHCM and PHCG should only be carried out in patients in whom surgical or radiological interventional procedures at the efferent venous pathways are planned.

scholarly journals P219 The role of color-coded duplex sonography in evaluating coronary-subclavian steal syndrome

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Antova ◽  
T S Tsvetanov ◽  
V Gelev ◽  
M Staneva
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Upper Limb ◽  
Coronary Arteriography ◽  
Duplex Sonography ◽  
Subclavian Steal Syndrome ◽  
Upper Limbs ◽  
Color Coded Duplex Sonography ◽  
Coronary Subclavian Steal Syndrome ◽  
Steal Syndrome

Abstract Background Coronary-subclavian steal syndrome is a rare phenomenon leading to dysfunction of left internal mammary artery (LIMA)-graft after coronary artery grafting with the occurrence of proximal stenosis of the left subclavian artery (LSA), which causes myocardial ischemia due to a blood-steal phenomenon through a fully patent LIMA-graft. Purpose To evaluate the role of color-coded duplex sonography (CCDS) in follow-up of all symptomatic patients with LIMA-graft after aorto-coronary bypass grafting (ACBG). Methods Two men and one woman with recurrence of angina pectoris symptoms and vertigo after ACBG with LIMA-LAD graft. Patients were hospitalized in cardiology for coronary graft assessment via selective coronary arteriography. Due to the discovery of fully patent grafts with a combination of varying degrees of proximal stenosis of the LSA, CCDS with a high-frequency linear probe was used to evaluate cervical arteries, LSA and the LIMA-graft flow rate applying functional probe for hyperemia (PH) of the left upper limb for hemodynamic assessment of significance of the steal syndrome. Results One woman at age 72 after ACBG – LIMA-LAD; RM1; RCA -s.v.g. Selective coronary arteriography showed patent bypass grafts with 70% proximal stenosis of LSA. The performed CCDS showed a LIMA-graft blood flow reduction from 36 ml/min to 12 ml/min in a sample for left upper limb hyperemia. There was a difference in the blood pressure of the upper limbs within 20 mmHg. Dobutamine stress echocardiography was performed, confirming ischemic zones in the LAD- peak segments. A 63 year old man after ACBG x 4 with a difference in blood pressure of upper limbs within 40 mmHg. The performed CCDS showed thrombosis of the left internal carotid artery, high-grade stenosis of the right internal carotid artery, high-grade stenosis of LSA, alternating blood flow in the left vertebral artery – a sign of hemodynamically significant steal syndrome. A 65 year old male after ACBG x 3 (LIMA-LAD, RCA, OM1 -s.v.g.). The selective coronary arteriography showed patent LIMA-graft with 50% proximal stenosis of LSA with a trans-stenotic pressure gradient of 20 mmHg. To identify the steal phenomenon we used CCDS, which showed a blood flow reduction into the LIMA-graft from 14.2 ml/min to 7.5 ml/ min - data of hemodynamically significant steal syndrome. Patients were treated with percutaneous transluminal angioplasty and stenting of the LSA with postprocedure reduction of angina pectoris complaints, no difference in the blood pressure of upper limbs and no reduction of LIMA-graft blood flow during the probe for hyperemia of the upper limb. Conclusion(s) Color-coded duplex sonography is an important and indispensable technique, part of the overall assessment of hemodynamics in case of coronary-subclavian steal syndrome and probably may prove to be a first method of choice in follow-up of all symptomatic patients with LIMA-LAD graft.

scholarly journals Predictive value of vertebral artery extracranial color-coded duplex sonography for ischemic stroke-related vertigo

2013 ◽  
Vol 29 (12) ◽  
pp. 667-672 ◽  
Author(s):  
Li-Min Liou ◽  
Hsiu-Fen Lin ◽  
I-Fang Huang ◽  
Yang-Pei Chang ◽  
Ruey-Tay Lin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Vertebral Artery ◽  
Predictive Value ◽  
Duplex Sonography ◽  
Color Coded Duplex Sonography

Cranioplasty and Duraplasty with Transcranial Color-Coded Duplex Sonography after Aneurysmal Subarachnoid Hemorrhage

2015 ◽  
Vol 24 (11) ◽  
pp. 2640-2645 ◽  
Author(s):  
Hirokazu Sadahiro ◽  
Akinori Inamura ◽  
Kazutaka Sugimoto ◽  
Akiko Yamane ◽  
Hideyuki Ishihara ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Duplex Sonography ◽  
Color Coded Duplex Sonography
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