Yield of transcranial Doppler in acute cerebral ischemia

Andrei Alexandrov, Andrew M. Demchuk, Theodore H. Wein, James C. Grotta

Research output: Contribution to journalArticle

144 Citations (Scopus)

Abstract

Background and Purpose - The objective of this study was to evaluate the yield of emergent transcranial Doppler (TCD) for the evaluation of acute cerebral ischemia. Methods - We performed urgent bedside non-contrast- enhanced TCD in patients with acute cerebral ischemia before or immediately after baseline CT scanning. A fast-track scanning protocol (≤15 minutes) and detailed diagnostic criteria were developed for portable single-channel TCD testing. TCD results were compared with angiography. Results - Of 130 consecutive patients studied, 36 were eligible for thrombolytic therapy; 46 with ischemic strokes and 48 with transient ischemic attacks were not eligible for thrombolysis. TCD identified occlusions in 69% of thrombolysis- eligible patients, compared with 24% and 0% of patients with strokes and transient ischemic attacks, respectively, not eligible for thrombolysis (P<0.01). Stenosis was present in 17%, 33%, and 35%, and normal vessels were found in 14%, 43%, and 65% in the respective patient subgroups. TCD also identified abnormal pulsatility of flow (12 patients), abnormal flow velocities (12), microembolic signals (5), or early recanalization (5) (34 of 130; 26%). In 65% of all patients, TCD was compared with angiography (digital subtraction angiography, MR angiography, or CT angiography). Despite a 15% rate of absent temporal windows, TCD had 88% accuracy for abnormal (occlusion and stenosis) versus normal vessels: sensitivity 87.5%, specificity 88.6%, positive predictive value 87.5%, and negative predictive value 88.6%. Conclusions - A proximal occlusion on TCD was found in 69% of thrombolysis- eligible patients. In 26% of all patients, TCD provided further relevant information that, in addition to angiography, helped to refine the severity of a stenosis and determine stroke pathogenesis. Emergent TCD is both sensitive and specific in determining arterial occlusion and stenosis in acute cerebral ischemia.

Original languageEnglish (US)
Pages (from-to)1604-1609
Number of pages6
JournalStroke
Volume30
Issue number8
DOIs
StatePublished - Jan 1 1999

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Brain Ischemia
Angiography
Pathologic Constriction
Stroke
Transient Ischemic Attack
Digital Subtraction Angiography
Thrombolytic Therapy
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

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

Cite this

Yield of transcranial Doppler in acute cerebral ischemia. / Alexandrov, Andrei; Demchuk, Andrew M.; Wein, Theodore H.; Grotta, James C.

In: Stroke, Vol. 30, No. 8, 01.01.1999, p. 1604-1609.

Research output: Contribution to journalArticle

Alexandrov, A, Demchuk, AM, Wein, TH & Grotta, JC 1999, 'Yield of transcranial Doppler in acute cerebral ischemia', Stroke, vol. 30, no. 8, pp. 1604-1609. https://doi.org/10.1161/01.STR.30.8.1604
Alexandrov, Andrei ; Demchuk, Andrew M. ; Wein, Theodore H. ; Grotta, James C. / Yield of transcranial Doppler in acute cerebral ischemia. In: Stroke. 1999 ; Vol. 30, No. 8. pp. 1604-1609.
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