Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, AL, USA.
Stroke. 2010 Apr;41(4):695-9. doi: 10.1161/STROKEAHA.109.565762. Epub 2010 Feb 18.
Intra-arterial (IA) rescue procedures are increasingly used to treat acute ischemic stroke. We implemented continuous transcranial Doppler (TCD) monitoring during these procedures to detect any potentially harmful flow changes. Here, we report diagnostic criteria and yield of TCD monitoring.
We studied consecutive acute stroke patients who underwent IA reperfusion procedures. TCD flow signatures during these procedures were analyzed and any abnormal findings were documented.
Patients were included only if there was successful insonation through the skull; of 56 eligible patients, 51 were included. IA procedures included IA tissue plasminogen activator, use of the Merci retriever, the Penumbra system, balloon angioplasty, and stenting. On TCD monitoring, contrast injections produced high-intensity signals and increased the mean flow velocity (MFV). Deployment of the Merci device appeared as high-intensity, short-duration signals with a transient MFV decrease of 11.5%. The Penumbra system produced lower-intensity signals with a greater transient decrease in MFV during aspiration. IA tissue plasminogen activator significantly increased MFV by 7.5% over Merci and Penumbra flow velocity changes. Power motion Doppler-TCD detected reocclusion in 13 patients, artery-to-artery embolization in 2 patients, air embolism in 2 patients, and hyperperfusion in 6 patients. Overall, the yield of TCD monitoring was positive in 23 (49%) patients who received IA reperfusion procedures.
Our velocity, intensity, and flow signatures criteria for TCD monitoring of IA reperfusion procedures detect reocclusion, hyperperfusion, or thromboembolism and air embolism in nearly half of all procedures. This hemodynamic information can be particularly helpful when neurological assessment is limited or delayed.
动脉内（IA）救援程序越来越多地用于治疗急性缺血性中风。我们在这些程序中实施了连续经颅多普勒（TCD）监测，以检测任何潜在的有害血流变化。在此，我们报告 TCD 监测的诊断标准和结果。
我们研究了连续进行 IA 再灌注程序的急性中风患者。分析了这些程序中的 TCD 流量特征，并记录了任何异常发现。
仅在成功经颅超声检查的情况下纳入患者；在 56 名合格患者中，有 51 名患者被纳入。IA 程序包括 IA 组织型纤溶酶原激活剂、使用 Merci 取栓器、Penumbra 系统、球囊血管成形术和支架置入术。在 TCD 监测中，造影剂注射会产生高强度信号并增加平均血流速度（MFV）。Merci 装置的部署表现为高强度、短持续时间的信号，MFV 短暂下降 11.5%。Penumbra 系统在抽吸过程中产生较低强度的信号，MFV 瞬态下降更大。IA 组织型纤溶酶原激活剂使 MFV 比 Merci 和 Penumbra 血流速度变化分别增加 7.5%。动力运动多普勒-TCD 在 13 名患者中检测到再闭塞，2 名患者中检测到动脉到动脉栓塞，2 名患者中检测到空气栓塞，6 名患者中检测到过度灌注。总体而言，在接受 IA 再灌注程序的 23 名（49%）患者中，TCD 监测的阳性结果。
我们的 IA 再灌注程序 TCD 监测的速度、强度和流量特征标准检测到再闭塞、过度灌注或血栓栓塞和空气栓塞，在近一半的程序中。在神经评估有限或延迟时，这种血流动力学信息特别有用。
