The Emerging Clinical Utility of Neurosonology During COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 infection. Over the last 2 years the virus has spread worldwide with enormous implications on the healthcare systems. COVID-19 patients suffer from mild upper-airway manifestations to pneumonia and severe acute respiratory distress syndrome and their hospitalizations are often prolonged. Neurological manifestations of the disease are common. Neurosonology (transcranial Doppler & cervical duplex ultrasound) is an easily repeatable diagnostic imaging modality that can be simply applied at the bedside of COVID-19 patients with cerebrovascular diseases or in critically ill patients in the intensive care unit. Neurosonology may provide hemodynamic assessment of cerebral circulation, quantitative evaluation of increased intracranial pressure and detection of micro-embolic signals in real-time. Consequently, it may assist substantially in the diagnosis, risk stratification and therapeutic approach of COVID-19 patients with or without cerebrovascular complications. In the present narrative review, we discuss the emerging clinical utility of neurosonology during COVID-19 pandemic and highlight the upgraded role of neurosonology resulting from the combination of the established applications coupled with the reduced risk of virus spreading during ultrasound evaluation compared to other imaging modalities including computed tomography and magnetic resonance imaging.

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Defining the Role of Duplex Ultrasound Assessment to Determine Severity of Arterial Calcification: An Analysis of the Superficial Femoral Artery

Journal for Vascular Ultrasound ◽

10.1177/1544316720910550 ◽

2020 ◽

Vol 44 (2) ◽

pp. 74-78

Author(s):

Charlotte Taylor ◽

Lukasz P. Zielinski ◽

Mohammed M. Chowdhury ◽

Patrick A. Coughlin

Keyword(s):

Computed Tomography ◽

Correlation Coefficient ◽

Lower Limb ◽

Imaging Modality ◽

Objective Assessment ◽

Duplex Ultrasound ◽

Arterial Calcification ◽

Gold Standard Method ◽

Calcification Score

Lower limb arterial calcification associates with poor cardiovascular outcomes. The gold standard method of assessment is via computed tomography, yet duplex is our primary imaging modality. Currently, there is no standardized objective assessment of lower limb arterial calcification using duplex. We aimed to define the role of duplex in the assessment of lower limb arterial calcification. Initial consensus was achieved between a cohort of vascular scientists on objective imaging specific markers of lower limb arterial calcification severity using duplex. This resulted in objective descriptions to grade calcification from 0 to 3 (no calcification through to severe calcification) which formed the duplex lower limb arterial calcification score. Reproducibility of the duplex lower limb arterial calcification score was assessed and further validation was undertaken by comparing the duplex lower limb arterial calcification with computed tomography–based assessment in a separate cohort of 44 patients investigated with both modalities. The intra- and inter-class correlation coefficient were > 0.87 . The Spearman rank correlation coefficient between the duplex and CT based arterial calcium measurements was (ρ = 0.644, P < .001). The duplex lower limb arterial calcification score provides a standardized and reproducible modality for assessment of lower limb arterial calcification and may aid with risk stratification in patients with peripheral arterial disease.

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Echoanatomical Patterns of the Long Saphenous Vein in Patients with Primary Varices and in Healthy Subjects

Phlebology The Journal of Venous Disease ◽

10.1177/026835559901400204 ◽

1999 ◽

Vol 14 (2) ◽

pp. 54-58 ◽

Cited By ~ 12

Author(s):

S. Ricci ◽

A. Caggiati

Keyword(s):

Saphenous Vein ◽

Healthy Subjects ◽

Duplex Ultrasound ◽

Normal Subjects ◽

Predisposing Factor ◽

Long Saphenous Vein ◽

Saphenous Veins ◽

Ultrasound Evaluation ◽

Congenital Origin

Objective: To evaluate the pathway of reflux in incompetent long saphenous veins (LSVs), paying particular attention to the role of longitudinal saphenous tributaries in the thigh (accessory saphenous veins, ASVs). Design: Prospective study in a group of patients with primary varices. Comparison with the anatomical patterns in a group of normal subjects. Setting: Private phlebology practice. Patients: Sixty-seven patients with primary varices (100 limbs) and 66 subjects without varices and with competent saphenous veins (120 limbs). Methods: Duplex ultrasound evaluation of the saphenous system in the thigh of patients and healthy subjects. The ‘eye’ ultrasonographic sign was used as the marker to distinguish the LSV from the longitudinal tributary veins of the thigh. Results: In 57% of limbs in patients with varices, reflux followed the saphenous vein, while in 43% the reflux spilled outside the LSV into an ASV (h or S types). When reflux followed the saphenous vein, no large calibre ASVs could be observed. In 30% of limbs in control subjects a parallel tributary vein with a similar calibre was found joining the LSV. Conclusion: Clinically visible varices in the thigh rarely comprise the LSV itself, but are usually dilated ASVs, the reflux stream passing from the proximal LSV into a more superficial ASV. The distal LSV running parallel beneath is often competent. In subjects with healthy LSVs, a large competent tributary vein is already present in the thigh in 30% of cases. This suggests that superficial deviation of reflux flow into an ASV in patients with varices may not arise from haemodynamically acquired changes, but could have a congenital origin. This could even be a predisposing factor in the development of varices.

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Staring Down Death

Crisis ◽

10.1027/0227-5910/a000367 ◽

2016 ◽

Vol 37 (3) ◽

pp. 212-217 ◽

Cited By ~ 7

Author(s):

Thomas E. Joiner ◽

Melanie A. Hom ◽

Megan L. Rogers ◽

Carol Chu ◽

Ian H. Stanley ◽

...

Keyword(s):

Suicide Risk ◽

Clinical Utility ◽

Blink Rate ◽

Specific Task ◽

Careful Planning ◽

Eye Blink ◽

Eye Blinks ◽

Potential Clinical Utility ◽

The Relationship

Abstract. Background: Lowered eye blink rate may be a clinically useful indicator of acute, imminent, and severe suicide risk. Diminished eye blink rates are often seen among individuals engaged in heightened concentration on a specific task that requires careful planning and attention. Indeed, overcoming one’s biological instinct for survival through suicide necessitates premeditation and concentration; thus, a diminished eye blink rate may signal imminent suicidality. Aims: This article aims to spur research and clinical inquiry into the role of eye blinks as an indicator of acute suicide risk. Method: Literature relevant to the potential connection between eye blink rate and suicidality was reviewed and synthesized. Results: Anecdotal, cognitive, neurological, and conceptual support for the relationship between decreased blink rate and suicide risk is outlined. Conclusion: Given that eye blinks are a highly observable behavior, the potential clinical utility of using eye blink rate as a marker of suicide risk is immense. Research is warranted to explore the association between eye blink rate and acute suicide risk.

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The Expanding Role of Echocardiography in Interventional Cardiology

European Cardiology Review ◽

10.15420/ecr.2010.6.2.71 ◽

2010 ◽

Vol 6 (2) ◽

pp. 71 ◽

Cited By ~ 3

Author(s):

Lindsay A Smith ◽

Amit Bhan ◽

Mark J Monaghan ◽

◽

...

Keyword(s):

Interventional Procedures ◽

Imaging Modality ◽

Interventional Cardiology ◽

Design And Technology ◽

Team Approach ◽

Medical Problems ◽

Multidisciplinary Team Approach ◽

Case Selection ◽

Optimal Imaging

Echocardiography provides excellent realtime imaging of the heart, making it the imaging modality of choice immediately before, during and after cardiac interventional procedures. It helps to guide case selection and execution of the intervention, evaluates the effects of the intervention and enables early detection of complications. Advances in the design and technology of medical devices and delivery systems, coupled with demand for alternative non-surgical therapies for common medical problems, have led to an increase in the volume, variety and complexity of non-coronary cardiac interventional procedures performed. Many of these procedures require a multidisciplinary team approach and demand optimal imaging to ensure successful outcomes. The aim of this article is to review the expanding role of echocardiography in non-coronary interventional cardiology in adults.

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The role of vinpocetine in the treatment of cerebrovascular diseases based on human studies

Orvosi Hetilap ◽

10.1556/oh.2007.28115 ◽

2007 ◽

Vol 148 (29) ◽

pp. 1353-1358 ◽

Cited By ~ 27

Author(s):

Edit Bagoly ◽

Gergely Fehér ◽

László Szapáry

Keyword(s):

Cerebrovascular Diseases ◽

Human Studies

Az agyérbetegségek jelentőségét jelzi, hogy a cardiovascularis és tumoros betegségek után a stroke jelenti a harmadik leggyakoribb halálokot világszerte. Mivel stroke során az érintett agyállomány irreverzíbilisen károsodik, az infarktust övező épen maradt, de általában hipoperfundált agyterületek működésének serkentésével lehet a betegek állapotán javítani. Az agyi véráramlás növelése révén várható javulás a stroke-on még át nem esett, de krónikus agyi hipoperfúzióban szenvedő betegek tüneteiben is. Célkitűzés, módszer: Jelen tanulmány célja, hogy áttekintse a vinpocetin akut és krónikus agyérbetegségekben történő alkalmazásának eddig publikált humán vizsgálati eredményeit, és összefoglaló képet adjon a gyógyszer főbb indikációs területeiről, az ott mutatott hatékonyságról. Eredmények: A vinpocetin akut ischaemiás stroke-ban történő alkalmazását vizsgáló tanulmányok száma csekély, eredményeik pedig ellentmondásosak. Krónikus agyérbetegek esetében mind az egyszeri, mind a hosszú távú vinpocetinkezelést követően PET-, SPECT-, TCD- és NIRS-vizsgálatokkal a laesio körüli ép agyterületek perfúziónövekedése, fokozott glükóz- és O 2 -felhasználása igazolódott, és jelentős javulás volt észlelhető a vér reológiai paramétereiben is. A klinikai hatékonyságot értékelő nemzetközi tanulmányok metaanalízise alapján a gyógyszer per os alkalmazásával szignifikáns javulás jelentkezik a kognitív teljesítményben és a napi aktivitásban. Következtetések: A fenti vizsgálatok eredményei alapján kimondható, hogy a vinpocetin sokrétű farmakológiai hatása révén kedvezően befolyásolja az agy ép területeinek perfúzióját és metabolizmusát, a vér áramlási viszonyait, javítva ezzel a krónikus agyérbetegek életminőségét.

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The Role of Inflammasomes in Atherosclerosis and Stroke Pathogenesis

Current Pharmaceutical Design ◽

10.2174/1381612826666200427084949 ◽

2020 ◽

Vol 26 (34) ◽

pp. 4234-4245

Author(s):

Deepaneeta Sarmah ◽

Aishika Datta ◽

Swapnil Raut ◽

Ankan Sarkar ◽

Birva Shah ◽

...

Keyword(s):

Atherosclerotic Plaque ◽

Treatment Strategies ◽

Cerebrovascular Diseases ◽

Cellular Injury ◽

Inflammatory Reactions ◽

Inflammatory Pathways

Inflammation is a devastating outcome of cerebrovascular diseases (CVD), namely stroke and atherosclerosis. Numerous studies over the decade have shown that inflammasomes play a role in mediating inflammatory reactions post cellular injury occurring after a stroke or a rupture of an atherosclerotic plaque. In view of this, targeting these inflammatory pathways using different pharmacological therapies may improve outcomes in patients with CVD. Here, we review the mechanisms by which inflammasomes drive the pathogenesis of stroke and atherosclerosis. Also, discussed here are the possible treatment strategies available for inhibiting inflammasomes or their up-stream/down-stream mediators.

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The Role of Atrial Fibrosis Detected by Delayed - Enhancement MRI in Atrial Fibrillation Ablation

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666180806130327 ◽

2020 ◽

Vol 16 (2) ◽

pp. 135-144 ◽

Cited By ~ 1

Author(s):

Zsuzsanna Kis ◽

Astrid Amanda Hendriks ◽

Taulant Muka ◽

Wichor M. Bramer ◽

Istvan Kovacs ◽

...

Keyword(s):

Atrial Fibrillation ◽

Imaging Modality ◽

Final Analysis ◽

Atrial Fibrosis ◽

Atrial Wall ◽

Af Ablation ◽

Left Atrial Wall ◽

Cmr Imaging

Introduction: Atrial Fibrillation (AF) is associated with remodeling of the atrial tissue, which leads to fibrosis that can contribute to the initiation and maintenance of AF. Delayed- Enhanced Cardiac Magnetic Resonance (DE-CMR) imaging for atrial wall fibrosis detection was used in several studies to guide AF ablation. The aim of present study was to systematically review the literature on the role of atrial fibrosis detected by DE-CMR imaging on AF ablation outcome. Methods: Eight bibliographic electronic databases were searched to identify all published relevant studies until 21st of March, 2016. Search of the scientific literature was performed for studies describing DE-CMR imaging on atrial fibrosis in AF patients underwent Pulmonary Vein Isolation (PVI). Results: Of the 763 citations reviewed for eligibility, 5 articles (enrolling a total of 1040 patients) were included into the final analysis. The overall recurrence of AF ranged from 24.4 - 40.9% with median follow-up of 324 to 540 days after PVI. With less than 5-10% fibrosis in the atrial wall there was a maximum of 10% recurrence of AF after ablation. With more than 35% fibrosis in the atrial wall there was 86% recurrence of AF after ablation. Conclusion: Our analysis suggests that more extensive left atrial wall fibrosis prior ablation predicts the higher arrhythmia recurrence rate after PVI. The DE-CMR imaging modality seems to be a useful method for identifying the ideal candidate for catheter ablation. Our findings encourage wider usage of DE-CMR in distinct AF patients in a pre-ablation setting.

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Feasibility and Clinical Utility of Ultra-Widefield–Navigated Swept-Source Optical Coherence Tomography Imaging

Journal of VitreoRetinal Diseases ◽

10.1177/2474126421997335 ◽

2021 ◽

pp. 247412642199733

Author(s):

Kyle D. Kovacs ◽

M. Abdallah Mahrous ◽

Luis Gonzalez ◽

Benjamin E. Botsford ◽

Tamara L. Lenis ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Clinical Utility ◽

Clinical Decision Making ◽

Imaging System ◽

Imaging Modality ◽

Case Series ◽

Subretinal Fluid ◽

Optical Coherence ◽

Swept Source ◽

Oct Imaging

Purpose: This work aims to evaluate the clinical utility and feasibility of a novel scanning laser ophthalmoscope-based navigated ultra-widefield swept-source optical coherence tomography (UWF SS-OCT) imaging system. Methods: A retrospective, single-center, consecutive case series evaluated patients between September 2019 and October 2020 with UWF SS-OCT (modified Optos P200TxE, Optos PLC) as part of routine retinal care. The logistics of image acquisition, interpretability of images captured, nature of the peripheral abnormality, and clinical utility in management decisions were recorded. Results: Eighty-two eyes from 72 patients were included. Patients were aged 59.4 ± 17.1 years (range, 8-87 years). During imaging, 4.4 series of images were obtained in 4.1 minutes, with 86.4% of the image series deemed to be diagnostic of the peripheral pathology on blinded image review. The most common pathologic findings were chorioretinal scars (18 eyes). In 31 (38%) eyes, these images were meaningful in supporting clinical decision-making with definitive findings. Diagnoses imaged included retinal detachment combined with retinoschisis, retinal hole with overlying vitreous traction and subretinal fluid, vitreous inflammation overlying a peripheral scar, Coats disease, and peripheral retinal traction in sickle cell retinopathy. Conclusions: Navigated UWF SS-OCT imaging was clinically practical and provided high-quality characterization of peripheral retinal lesions for all eyes. Images directly contributed to management plans, including laser, injection or surgical treatment, for a clinically meaningful set of patients (38%). Future studies are needed to further assess the value of this imaging modality and its role in diagnosing, monitoring, and treating peripheral lesions.

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