Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia

Oleg Y. Chernyshev, Zsolt Garami, Sergio Calleja, Joon Song, Morgan S. Campbell, Elizabeth A. Noser, Hashem Shaltoni, Chin I. Chen, Yasuyuki Iguchi, James C. Grotta, Andrei Alexandrov

Research output: Contribution to journalArticle

107 Citations (Scopus)

Abstract

Background and Purpose - 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). Methods - 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, ≥50% stenoses or thrombus in the symptomatic artery. Results - 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 ≥ 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. Conclusions - Bedside neurovascular ultrasound examination, combining carotid/vertebral duplex with TCD yields a substantial proportion of LAITs in excellent agreement with urgent DSA.

Original languageEnglish (US)
Pages (from-to)32-37
Number of pages6
JournalStroke
Volume36
Issue number1
DOIs
StatePublished - Jan 1 2005

Fingerprint

Brain Ischemia
Digital Subtraction Angiography
Stroke
National Institutes of Health (U.S.)
Therapeutics
Transient Ischemic Attack
Pathologic Constriction
Thrombosis
Arteries
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia. / 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.

In: Stroke, Vol. 36, No. 1, 01.01.2005, p. 32-37.

Research output: Contribution to journalArticle

Chernyshev, OY, Garami, Z, Calleja, S, Song, J, Campbell, MS, Noser, EA, Shaltoni, H, Chen, CI, Iguchi, Y, Grotta, JC & Alexandrov, A 2005, 'Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia', Stroke, vol. 36, no. 1, pp. 32-37. https://doi.org/10.1161/01.STR.0000150496.27584.e3
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. / Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia. In: Stroke. 2005 ; Vol. 36, No. 1. pp. 32-37.
@article{2c5494ee411e441ebd3a690c799d114f,
title = "Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia",
abstract = "Background and Purpose - 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). Methods - 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, ≥50{\%} stenoses or thrombus in the symptomatic artery. Results - 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 ≥ 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. Conclusions - Bedside neurovascular ultrasound examination, combining carotid/vertebral duplex with TCD yields a substantial proportion of LAITs in excellent agreement with urgent DSA.",
author = "Chernyshev, {Oleg Y.} and Zsolt Garami and Sergio Calleja and Joon Song and Campbell, {Morgan S.} and Noser, {Elizabeth A.} and Hashem Shaltoni and Chen, {Chin I.} and Yasuyuki Iguchi and Grotta, {James C.} and Andrei Alexandrov",
year = "2005",
month = "1",
day = "1",
doi = "10.1161/01.STR.0000150496.27584.e3",
language = "English (US)",
volume = "36",
pages = "32--37",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia

AU - Chernyshev, Oleg Y.

AU - Garami, Zsolt

AU - Calleja, Sergio

AU - Song, Joon

AU - Campbell, Morgan S.

AU - Noser, Elizabeth A.

AU - Shaltoni, Hashem

AU - Chen, Chin I.

AU - Iguchi, Yasuyuki

AU - Grotta, James C.

AU - Alexandrov, Andrei

PY - 2005/1/1

Y1 - 2005/1/1

N2 - Background and Purpose - 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). Methods - 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, ≥50% stenoses or thrombus in the symptomatic artery. Results - 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 ≥ 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. Conclusions - Bedside neurovascular ultrasound examination, combining carotid/vertebral duplex with TCD yields a substantial proportion of LAITs in excellent agreement with urgent DSA.

AB - Background and Purpose - 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). Methods - 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, ≥50% stenoses or thrombus in the symptomatic artery. Results - 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 ≥ 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. Conclusions - Bedside neurovascular ultrasound examination, combining carotid/vertebral duplex with TCD yields a substantial proportion of LAITs in excellent agreement with urgent DSA.

UR - http://www.scopus.com/inward/record.url?scp=19944426495&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=19944426495&partnerID=8YFLogxK

U2 - 10.1161/01.STR.0000150496.27584.e3

DO - 10.1161/01.STR.0000150496.27584.e3

M3 - Article

VL - 36

SP - 32

EP - 37

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 1

ER -