FAST

1. FAST FAST Flow-Assisted Surgical Technique In Cerebrovascular Surgery

2. HT300-Series Features Computes Trans-Time Volume Flow Measurements in mL/min Received Signal Mean Flow Waveform Printer FlowSound

3. Charbel Mircro-Flowprobes Designed for Intra-Cranial Use Available in 1.5, 2, and 3mm sizes Bayonet Handle for use under the microscope Malleable probe tip

4. Short Handle Charbel Flowprobes Designed for Extra-Cranial Use Available in 3, 4, and 6 mm Bayonet handle for use under the microscope Malleable tip

5. Theory of Operation Ultrasound transducers send and receive signals which are altered by blood flow.

7. Charbel Micro-Flowprobes Provide real-time quantitative Flows in cerebral vessels, intra-operatively. Quick, and easy to use.

8. Comparing TTU to Doppler

9. Comparing TTU to Doppler

10. FAST Quantitative Confirmation Flow is preserved during aneurysm clippings Flow is replaced during aneurysm trappings Flow is augmented to ischemic areas

11. Aneurysm Clippings Intra-operative flow measurements have been shown to indicate clipping adjustments in up to 30% of aneurysm cases Preserve Blood Flow in Parent and Distal Vessels Prevent Stroke

12. Identify Vessels at risk • Dissect fat and tissue from vessels in preparation for Flow measurements. Aneurysm Exposure

13. Flowprobe Fit Vessel should fill 60-95% of the probe lumen

14. Place Flowprobe Flood area with normal Saline to establish acoustic signal

15. Taking Measurements Check Signal Print Waveform Record Mean Flow

18. Clip, Re-Measure, and Compare to Baseline

20. Reduction? Generally, a 25% reduction is a cause for concern

21. Adjust and Measure as Needed

22. SCA Aneurysm Case Baseline 18 mL/min Post-Clip4 mL/min Adjustment18 mL/min

23. EC-IC Bypass Replacement: Bypass replaces Flow the deficit created by an aneurysm trapping, or vessel sacrifice Augmentation Bypass Increases Flow to vessels with naturally occurring occlusive cerebrovascular disease

24. Cut Flow Measurement

25. Evaluating Adequacy Courtesy of FT Charbel, MD, FACS

26. Flow Replacement Protocol Calculate Flow Deficit created by vessel occlusion / trapping Match supply to demand by Checking the Cut Flow of donor artery Immediately evaluate patency and success of bypass

27. Giant Cavernous Carotid Case

28. Augmentation ECA-PCA Bypass Bypass for ischemia in posterior circulation

29. Cut Flow Index Completed Bypass Flow Cut Flow Index = Cut Flow of donor artery

31. Predictability A Cut Flow Index > 0.5 has been shown as a sensitive predictor of bypass function. In 51 bypass cases: The Cut Flow Index: An Intra-Operative Predictor of the Success of EC-IC Bypass for Occlusive Cerebrovascular Disease. Amin-Hanjani, S, Du, X., Milnarevich, N., Meglio G., Zhao, M., Charbel, FT, Neurosurgery. 2005 56(1) Suppl: 75-85 92% patency rate when CFI > 0.5 50% patency rate when CFI < 0.

32. FAST Summary Quantitative Confirmation Flow is preserved during aneurysm clippings Flow is replaced during aneurysm trappings Flow is augmented to ischemic areas

33. FAST Leaders USA University of Illinois at Chicago, Chicago, IL Charbel, Fady T., MD, Chair, Neuropsychiatric Institute (MC 799), Department of Neurosurgery Stanford University School of Medicine, Palo Alto, CA Steinberg, Gary K., MD, Chair, Department of Neurosurgery Harvard University, Cambridge, MA Olgilvy, Christopher S., MD, Professor of Neurosurgery, Attending neurosurgeon, Mass General Hospital Mayo Clinic, Rochester, MN Meyer, Fred B. MD, Chair, Department of Neurosurgery St. Luke's-Roosevelt Hospital Center and Albert Einstein College of Medicine, NY Langer, David J., MD, Department of Neurosurgery/INN University of Miami, Miami, FLMarcos, Jacque, MD, Associate Professor Germany University of Mannheim, Mannheim, Germany Vajkoczy, Peter, MD, Department of Neurosurgery Netherlands University Utrecht, Utrecht, Netherlands Van der Zwan, Bart, MD, Professor, Department of Neurosurgery, Streefkerk, H.J.Tulleken, C.A. (retired 2005) University Maastricht, Maastricht, Netherlands Dings, Jim MD, Department of Neurosurgery, Spincemaille, Geert, MD, Department of Neurosurgery, Italy University Verona, Verona, Italy Pasqualin, A., MD, Department of Neurosurgery University Padova, Padova, ItalyScienza, R, Prof, Department of Neurosurgery Pavesi, Giacomo, MD, Department of Neurosurgery Japan Hokkaido University School of Medicine, Sapporo , Japan Nakayama, N., MD Department of Neurosurgery Taiwan Tu, MD National Taiwan University Lin - Veterins General Hospital – Taipei Australia Khuranna, MD, Canberra

34. www.transonicasia.com/neuro

35. Extra-Corporeal Tissue Perfusion Research Cardiovascular Neuro Dialysis Angioplasty VAD / OEM

36. Proven Independently validated in many applications and referenced in over 4,000 publications in the past 25 years.

37. Thank You