Chernyshev Oleg Y, Garami Zsolt, Calleja Sergio, Song Joon, Campbell Morgan S, Noser Elizabeth A, Shaltoni Hashem, Chen Chin-I, Iguchi Yasuyuki, Grotta James C, Alexandrov Andrei V
Stroke Treatment Team, University of Texas-Houston, Texas 77005, USA.
Stroke. 2005 Jan;36(1):32-7. doi: 10.1161/01.STR.0000150496.27584.e3. Epub 2004 Nov 29.
We routinely perform an urgent bedside neurovascular ultrasound examination (NVUE) with carotid/vertebral duplex and transcranial Doppler (TCD) in patients with acute cerebral ischemia. We aimed to determine the yield and accuracy of NVUE to identify lesions amenable for interventional treatment (LAITs).
NVUE was performed with portable carotid duplex and TCD using standardized fast-track (<15 minutes) insonation protocols. Digital subtraction angiography (DSA) was the gold standard for identifying LAIT. These lesions were defined as proximal intra- or extracranial occlusions, near-occlusions, > or =50% stenoses or thrombus in the symptomatic artery.
One hundred and fifty patients (70 women, mean age 66+/-15 years) underwent NVUE at median 128 minutes after symptom onset. Fifty-four patients (36%) received intravenous or intra-arterial thrombolysis (median National Institutes of Health Stroke Scale (NIHSS) score 14, range 4 to 29; 81% had NIHSS > or =10 points). NVUE demonstrated LAITs in 98% of patients eligible for thrombolysis, 76% of acute stroke patients ineligible for thrombolysis (n=63), and 42% in patients with transient ischemic attack (n=33), P<0.001. Urgent DSA was performed in 30 patients on average 230 minutes after NVUE. Compared with DSA, NVUE predicted LAIT presence with 100% sensitivity and 100% specificity, although individual accuracy parameters for TCD and carotid duplex specific to occlusion location ranged 75% to 96% because of the presence of tandem lesions and 10% rate of no temporal windows.
Bedside neurovascular ultrasound examination, combining carotid/vertebral duplex with TCD yields a substantial proportion of LAITs in excellent agreement with urgent DSA.
我们常规对急性脑缺血患者进行床边紧急神经血管超声检查（NVUE），包括颈动脉/椎动脉双功超声和经颅多普勒（TCD）。我们旨在确定NVUE识别适合介入治疗的病变（LAITs）的检出率和准确性。
使用便携式颈动脉双功超声和TCD，按照标准化快速流程（<15分钟）进行NVUE检查。数字减影血管造影（DSA）是识别LAITs的金标准。这些病变定义为近端颅内或颅外闭塞、近乎闭塞、有症状动脉中≥50%的狭窄或血栓。
150例患者（70例女性，平均年龄66±15岁）在症状发作后中位时间128分钟接受了NVUE检查。54例患者（36%）接受了静脉或动脉溶栓治疗（美国国立卫生研究院卒中量表（NIHSS）中位评分14分，范围4至29分；81%的患者NIHSS≥10分）。NVUE在98%适合溶栓的患者、76%不适合溶栓的急性卒中患者（n = 63）和42%短暂性脑缺血发作患者（n = 33）中检测到LAITs，P<0.001。平均在NVUE检查后230分钟对30例患者进行了紧急DSA检查。与DSA相比，NVUE预测LAITs存在的敏感性和特异性均为100%，尽管由于串联病变的存在以及10%的无颞窗率，TCD和颈动脉双功超声针对闭塞部位的个体准确性参数范围为75%至96%。
床边神经血管超声检查，将颈动脉/椎动脉双功超声与TCD相结合，能检测出相当比例的LAITs，与紧急DSA结果高度一致。
