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Neurosonolog y in acute stroke patients

Neurosonolog y in acute stroke patients. Š koloudík D. Department of Neurology University Hospital Ostrava & Olomouc. Neurosonology. Duplex sonography of cervical arteries Duplex sonography of eyehole (ophthalmic artery, optical nerve) Transcranial Doppler Transcranial duplex sonography.

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Neurosonolog y in acute stroke patients

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  1. Neurosonology in acute stroke patients Školoudík D. Department of Neurology University Hospital Ostrava & Olomouc

  2. Neurosonology • Duplex sonography of cervical arteries • Duplex sonography of eyehole (ophthalmic artery, optical nerve) • Transcranial Doppler • Transcranial duplex sonography

  3. Methodology • Necessity of fast diagnostic – occlusion or stenosis of cervical or intracranial artery for a choosing the best therapeutical method • Examination must not exceed 5 – 10 minutes • Echocontrast agent use

  4. Carotids • Stenosis • Occlusion • Dissection • Arteriitis

  5. Evaluation of stenosis • PSV – best correlation with DSA (sensitivity, specificity approx. 90%) • EDV • PSV ICA/PSV CCA, EDV ICA/EDV CCA • Lumen reduction, area • Calcification!!!

  6. Chronic vs. acute occlusion • B-mode (anechogenic acute thrombus) • Collateral flow • Asymmetric PSV in MCA´s

  7. Vertebral arteries • Stenosis • Occlusion • Steal syndom • Dissection

  8. Eyehole

  9. TCCS/TCD • 1-4/2 MHz probe, (MI 1.5, TIS 1.2) • TCCS: B-mode, M-mode, color mode, power mode, Doppler mode • TCD: Doppler mode, Power M-mode • Acoustic window - temporal, suboccipital, frontal, occipital, orbital, submandibular

  10. Acute stroke • Occlusion of intracranial stenosis • Intracranial artery stenosis • Hemodynamic changes (e.g. ICA occlusion) • HITS / MES • Haemorhage • Angiopathy • Intracranial hypertension

  11. Artery occlusion • Main: B-mode (MCA), Doppler mode (no flow in occlusion, low PSV and high PI, RI proximaly to the occlusion) • Other: color mode, power mode, detection of collaterals

  12. Occlusion of MCA branches • Asymmetry in PSV (Zanette index 1.3, 30% site-to-site difference, TIBI criteria) • Increase of PI a RI

  13. Artery stenosis - dg. criteria • Main: local jet with PSV ratio more than 1.5 • Other: turbulent flow, aliasing in color mode, lumen narrowing in power mode

  14. stenosis poststenotic • PSV-S/PSV-Z = 267.1/70.4 = 3.78 … grade III

  15. Grading of stenosis US AG • Grade I: PSV index 1.5-1.99 … 20-39% • Grade II: PSV index 2.0-2.99 … 40-59% • Grade III: PSV index > =3.0 … >= 60% • Correlation: kappa coefficient: 0.68

  16. Angiopathy

  17. Haemorrhage

  18. Increasing of intracranial pressure

  19. Thrombosis of cerebral sinuses

  20. Limitation • Dependence on sonographer experience • Insufficient bone window (8 – 20%)

  21. % age (years) male female

  22. Echocontrast agents • Bolus injection - 0.2-0.5 ml Optison (1:10) nebo 0.5ml SonoVue • Blooming! • Increasing of a Doppler signal for about 1 minute

  23. Monitoring • Monitoring HITS / MES • Monitoring of artery recanalization • Sonothrombotripsy, sonothrombolysis

  24. Microembolus

  25. Microembolus

  26. Thanks for your attention

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