Lao A Y, Sharma V K, Tsivgoulis G, Malkoff M D, Alexandrov A V, Frey J L
Neurosonology and Stroke Research Program, Barrow Neurological Institute, Phoenix, AZ, USA.
Eur J Neurol. 2007 Sep;14(9):1035-9. doi: 10.1111/j.1468-1331.2007.01879.x.
We adopted an expanded transcranial Doppler (TCD) protocol to evaluate if additional injections of agitated saline in different positions would improve shunt detection or grading. We report the safety and feasibility of this expanded contrast TCD protocol. Patients with ischemic stroke were evaluated. The standard protocol for RLS detection was followed and expanded after the initial injection in the supine position to the right lateral decubitus, upright sitting, and sitting with right lateral leaning. Changes in blood pressure, heart rate, and any subjective complaints were noted. Changes in body position and additional agitated saline injections were tolerated. Right-to-left shunt (RLS) was detected in 35% of patients (n = 55). If the initial supine testing was negative, all subsequent positions/injections were also negative for RLS. However, if the supine injection was positive for RLS, the change in body positions increased the microbubble (microB) count in eight of 19 (42%) RLS-positive patients. The mean microB count in RLS-positive patients was 20 (95% CI: 9-32). The use of three additional body positions increased the microB count to 73 (95% CI: 13-132). The highest microB yield was achieved in the upright sitting position. Our findings support the safety and feasibility of the expanded TCD protocol. If the initial supine Valsalva-aided contrast TCD test is negative, there may be no need to study the patient in additional positions. However, if microB are detected in the supine position, additional testing for RLS in alternative positions may be found to be worthwhile.
我们采用了一种扩展的经颅多普勒（TCD）方案，以评估在不同体位额外注射振荡生理盐水是否会改善分流检测或分级。我们报告了这种扩展的对比TCD方案的安全性和可行性。对缺血性中风患者进行了评估。遵循检测右向左分流（RLS）的标准方案，并在仰卧位首次注射后扩展至右侧卧位、直立坐位和右侧倾斜坐位。记录血压、心率的变化以及任何主观不适。体位变化和额外注射振荡生理盐水均能耐受。35%的患者（n = 55）检测到右向左分流（RLS）。如果初始仰卧位检测为阴性，所有后续体位/注射的RLS检测也均为阴性。然而，如果仰卧位注射的RLS检测为阳性，体位变化使19例RLS阳性患者中的8例（42%）微泡（microB）计数增加。RLS阳性患者的平均微泡计数为20（95%可信区间：9 - 32）。使用另外三个体位使微泡计数增加到73（95%可信区间：13 - 132）。直立坐位时微泡产量最高。我们的研究结果支持扩展TCD方案的安全性和可行性。如果初始仰卧位瓦尔萨尔瓦动作辅助对比TCD检测为阴性，可能无需在其他体位对患者进行检查。然而，如果在仰卧位检测到微泡，在其他体位进行额外的RLS检测可能是值得的。
