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Albricker ACL, Freire CMV, Santos SND, Alcantara MLD, Cantisano AL, Porto CLL, Amaral SID, Veloso OCG, Morais Filho DD, Teodoro JAR, Petisco ACGP, Saleh MH, Barros MVLD, Barros FS, Engelhorn ALDV, Engelhorn CA, Nardino ÉP, Silva MADM, Biagioni LC, Souza AJD, Sarpe AKP, Oliveira ACD, Moraes MRDS, Francisco Neto MJ, Françolin PC, Rochitte CE, Iquizli R, Santos AASMDD, Muglia VF, Naves BDL. Recommendation Update for Vascular Ultrasound Evaluation of Carotid and Vertebral Artery Disease: DIC, CBR and SABCV - 2023. Arq Bras Cardiol 2023; 120:e20230695. [PMID: 37991060 DOI: 10.36660/abc.20230695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
- Ana Cristina Lopes Albricker
- Centro Universitário de Belo Horizonte (UniBH), Belo Horizonte, MG - Brasil
- IMEDE - Instituto Mineiro de Ultrassonografia, Belo Horizonte, MG - Brasil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Empresa Brasileira de Serviços Hospitalares (UBSERH), Brasília, DF - Brasil
| | | | | | | | | | | | - Orlando Carlos Glória Veloso
- Rede UnitedHealth Group (UHG), Rio de Janeiro, RJ - Brasil
- Hospital Pasteur, Rio de Janeiro, RJ - Brasil
- Hospital Américas, Rio de Janeiro, RJ - Brasil
- Hospital de Clínicas Mário Lioni, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Érica Patrício Nardino
- Faculdade de Medicina do ABC Paulista, SP - Brasil
- Faculdade de Medicina Unoeste, Guarujá, SP - Brasil
| | | | | | | | | | | | | | | | - Peter Célio Françolin
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (Hcor), São Paulo, SP - Brasil
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Low Vertebrobasilar Velocity Is Associated with a Higher Risk of Posterior Circulation Ischemic Lesions. J Clin Med 2022; 11:jcm11051396. [PMID: 35268487 PMCID: PMC8911347 DOI: 10.3390/jcm11051396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Transcranial color-coded sonography (TCCS) is used as a real-time tool to evaluate patients suspected of having vertebrobasilar insufficiency (VBI). However, the sonographic criteria for VBI remain inconclusive. The purpose of this study was to analyze the velocity in the vertebrobasilar system, which links the risk for posterior circulation infarction (POCI) and total ischemic stroke (TIS) in patients with VBI. Methods: Patients’ data were retrospectively reviewed if they were suspected of having VBI within a 2-year period. Baseline characteristics, brain images, and a series of sonography data were recorded and analyzed. We compared vertebrobasilar (VB) velocities in different age groups and in patients with infarctions. Results: A total of 875 patients were enrolled, with 112 and 427 candidates in the POCI and TIS groups, respectively. The mean velocity (MV)s of BA and bilateral VAs were all negatively correlated with age (all p < 0.001). The adjusted odds ratio was 2.55 (1.58−4.13, p < 0.001) in POCI and 1.75 (1.15−2.67, p = 0.009) in TIS if the mean velocity of the VB arteries was below 15 cm/s. Conclusions: Low VB velocity detected in TCCS was more commonly associated with ageing-related changes and a higher risk of both POCI and TIS. Recognition and aggressive treatment for these patients are necessary.
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Matsumura Y, Yamanaka T, Murai T, Fujita N, Kitahara T. Orthostatic hemodynamics in the vertebral artery and blood pressure in patients with orthostatic dizziness/vertigo. Auris Nasus Larynx 2021; 49:593-598. [PMID: 34930632 DOI: 10.1016/j.anl.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/07/2021] [Accepted: 12/02/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Orthostatic dizziness/vertigo (ODV) is a common symptom and is believed to occur due to the cerebral hypoperfusion caused by orthostatic hypotension (OH). However, the detailed mechanism underlying ODV onset is poorly understood. The vertebral artery (VA) mainly supplies blood to the central vestibular system; therefore, the orthostatic decrease of VA blood flow could possibly lead to ODV. This study investigated the orthostatic blood pressure and VA hemodynamics in ODV patients to elucidate the hemodynamic mechanism underlying ODV onset. Furthermore, the influence of orthostatic hypotension (OH) on VA hemodynamics was examined because OH is probably the most common cause of ODV. METHODS This study included 181 patients with ODV and 73 control patients without ODV. All subjects underwent an active standing test to measure the extracranial Doppler (ECD) sonography spectrum of the VA and blood pressure (BP). VA blood flow velocity and BP were simultaneously measured for each patient in the supine static position and then in the upright standing positions following 3 min of standing. We investigated the orthostatic change in the average of flow velocity in bilateral VAs (VAFV) and BP for ODV patients compared with the control patients. RESULT VAFV in ODV patients was significantly reduced when standing up compared with the control patients. In the ODV patients, there was no difference in orthostatic decrease in VAFV between patients those with OH and without OH. However, the VAFV in the standing position was significantly lower in patients with OH than without OH. In cases with OH, the ODV patients exhibited a greater decrease in VAFV compared with the control patients, but this was not statistically significant. In the absence of OH, a significantly greater orthostatic decrease in VAFV was observed in ODV patients compared with the controls. CONCLUSION Our findings suggest that the orthostatic decrease of VA blood flow is deeply involved in the hemodynamic mechanism underlying ODV onset and is possibly associated with OH and other etiologies.
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Affiliation(s)
- Yachiyo Matsumura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University School of Medicine Address: 840 Shijo, Kashihara Nara, 634-8522, Japan
| | - Toshiaki Yamanaka
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University School of Medicine Address: 840 Shijo, Kashihara Nara, 634-8522, Japan..
| | - Takayuki Murai
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University School of Medicine Address: 840 Shijo, Kashihara Nara, 634-8522, Japan
| | - Nobuya Fujita
- Department of Otorhinolaryngology, Osaka Kaisei Hospital, Address: 1-6-10 Miyahara, Yodogawa-ku, Osaka, 532-0003, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University School of Medicine Address: 840 Shijo, Kashihara Nara, 634-8522, Japan
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Santos SND, Alcantara MLD, Freire CMV, Cantisano AL, Teodoro JAR, Porto CLL, Amaral SID, Veloso O, Albricker ACL, Petisco ACGP, Barros FS, Barros MVL, Saleh MH, Vieira MLC. Vascular Ultrasound Statement from the Department of Cardiovascular Imaging of the Brazilian Society of Cardiology - 2019. Arq Bras Cardiol 2019; 112:809-849. [PMID: 31314836 PMCID: PMC6636370 DOI: 10.5935/abc.20190106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Monica Luiza de Alcantara
- Americas Medical City, Rio de Janeiro, RJ - Brazil.,Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | | | | | | | - Salomon Israel do Amaral
- Americas Medical City, Rio de Janeiro, RJ - Brazil.,Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | | | | | | | | | | | - Marcelo Luiz Campos Vieira
- Universidade de São Paulo (USP), São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil.,Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, SP - Brazil
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梁 毅, 丘 丽, 谢 静. [Subclavian artery stenosis combined with vertebral artery stenosis may lead to compensatory blood flow changes in the contralateral vertebral artery]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:1509-1513. [PMID: 30613022 PMCID: PMC6744209 DOI: 10.12122/j.issn.1673-4254.2018.12.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the severity of blood steal and the hemodynamic profiles in patients with subclavian artery stenosis combined with vertebral artery stenosis. METHODS A retrospective analysis was performed of transcranial Doppler (TCD) data from patients with subclavian artery stenosis (SAS) and concomitant unilateral/bilateral vertebral artery stenosis (VAS, >50%) or occlusion in our institution between February, 2014 and July, 2018.Thirty-seven patients with SAS combined with VAS (SAS+VAS) were reviewed for types of blood steal, peak systolic velocities of blood flow in affected subclavian artery and the contralateral vertebral artery, and the findings of hyperemia testing.These data were also reviewed for 39 SAS patients without VAS (control group) for comparison of blood steal and hemodynamic profiles. RESULTS In SAS+VAS group, 5 patients showed no blood steal; blood steal in stage Ⅰ was found in 22 patients, stage Ⅱ in 7, and stage Ⅲ in 3, as compared to the numbers of 17, 12 and 10 in the control group, respectively (H=9.431, P=0.002).The peak systolic velocity of the contralateral vertebral artery was 43.91±17.43 cm/s in SAS+VAS group, significantly lower than that in the control group (53.56±17.45 cm/s; t= 629.5, P=0.006).Hyperemia testing showed a significant difference in the negative rate between SAS+VAS group and the control group[35.1%(13/37) vs 7.7%(3/39);χ2=8.603, P=0.003). CONCLUSIONS SAS combined with VAS may lead to reduced compensatory blood flow in the contralateral vertebral artery to lessen the severity of subclavian steal syndrome.
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Affiliation(s)
- 毅仪 梁
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
| | - 丽雅 丘
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
| | - 静芳 谢
- />广东省人民医院(广东省医学科学院)神经科//广东省神经科学研究所,广东 广州 510080Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou 510080, China
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Chi HY, Hsu CF, Chen AC, Su CH, Hu HH, Fu WM. Extracranial and Intracranial Ultrasonographic Findings in Posterior Circulation Infarction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1605-1610. [PMID: 29193196 DOI: 10.1002/jum.14501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/21/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Patients with posterior circulation infarction are at higher risk of early recurrent stroke, especially those with vertebrobasilar stenosis or hypoplasia. The clinical presentations of this condition vary over a broad range, making diagnosis and treatment a challenge. Hemodynamic changes and stenosis detected by ultrasonography (US) are sensitive and important indicators for further evaluation. In this study, we correlated extracranial and intracranial US characteristics with brain magnetic resonance imaging (MRI) in patients with posterior circulation infarction. METHODS Inpatients with acute ischemic stroke who received both MRI and US were enrolled. Baseline characters, underlying disorders, the ischemic territory, and vascular stenosis on MRI were recorded. Series of US data, including flow volume, diameter, mean velocity, and pulsatility index, were analyzed. Patients with new infarction over the medulla, pons, midbrain, or cerebellum were enrolled as the posterior circulation infarction group. Patients with pure anterior circulation infarction were also enrolled. RESULTS A total of 210 patients with anterior circulation infarction (mean age ± SD, 66.24 ± 12.88 years) and 143 with posterior circulation infarction (mean age, 65.82 ± 11.39 years) were enrolled. Significant higher frequencies of vertebral artery hypoplasia and decreased intracranial vertebrobasilar velocity in the posterior circulation infarction group (44.75% and 64.33%, respectively) were documented (P < .0001; P = .035). Ischemic lesion distributions were correlated with vertebral artery hypoplasia (55.56 %) and low vertebral and basilar artery velocities (44.44% and 25.53%), as documented by US. A low vertebrobasilar velocity was highly correlated with MRI-documented vascular stenosis (53.06%). CONCLUSIONS Vertebral artery hypoplasia and a low velocity in the intracranial vertebrobasilar system on US might change the treatment of patients with posterior circulation infarction for primary and secondary prevention.
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Affiliation(s)
- Hsin-Yi Chi
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Pharmacological Institute, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Fu Hsu
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - An-Chih Chen
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Hung Su
- Department of Internal Medicine, Division of Cardiology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Han-Hwa Hu
- Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University and Hospital, Taipei, Taiwan
| | - Wen-Mei Fu
- Pharmacological Institute, College of Medicine, National Taiwan University, Taipei, Taiwan
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Qureshi AI, Chaudhry SA, Eckstein H, Jansen O, Ringleb PA. Asymptomatic Extracranial Vertebral Artery Disease in Patients with Internal Carotid Artery Stenosis. Neurosurgery 2017; 81:531-536. [PMID: 28379549 DOI: 10.1093/neuros/nyx092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/22/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Extracranial vertebral artery disease is seen in patients with internal carotid artery stenosis, although the clinical significance is not well understood. OBJECTIVE To determine the prevalence and natural history of extracranial vertebral artery disease in patients with recently symptomatic internal carotid artery stenosis. METHODS We analyzed data collected for patients with recently symptomatic internal carotid artery stenosis in the Stent-Protected Angioplasty vs Carotid Endarterectomy trial. We used Cox proportional hazards analysis to compare the relative risk of various endpoints (any stroke, ipsilateral stroke, and death) between the 3 categories of extracranial vertebral artery disease (normal/hypoplastic, moderate/severe stenosis, occlusion) adjusting for age, gender, severity of internal carotid artery stenosis at baseline (<70% and ≥70%), allocated procedure (carotid angioplasty and stent placement or carotid endarterectomy) and hypertension. RESULTS Moderate to severe stenosis and occlusion of 1 of both extracranial vertebral arteries were diagnosed in 152 (12.9%) and 57 (4.8%) of 1181 subjects, respectively. Comparing subjects with normal or hypoplastic vertebral artery, there was nonsignificant 30%, 40%, and 50% higher risk of any stroke (hazard ratio [HR] 1.3, 95% confidence interval [CI] 0.7-2.3), ipsilateral stroke (HR 1.4, 95% CI 0.7-2.5), and death (HR 1.5, 95% CI 0.7-3.1) among subjects with moderate to severe vertebral artery stenosis after adjusting for potential confounders. CONCLUSIONS There may be an increased risk of stroke and death in patients with symptomatic internal carotid artery stenosis with concurrent asymptomatic extracranial vertebral artery stenosis.
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Affiliation(s)
| | - Saqib A Chaudhry
- Department of Neur-ology and Ophthalmology, Michigan State University, Lansing, Michigan
| | - Henning Eckstein
- Department of Vascular Surgery, Medical Center, Technical University of Munich, Germany
| | - Olav Jansen
- Department of Radio-logy and Neuroradiology, University of Kiel, Arnold-Heller Str.3, Kiel, Germany
| | - Peter A Ringleb
- Department of Neurology, Universitä-tsklinikum Heidelberg, University of Heidelberg, Heidelberg, Germany
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Tsai LK, Yeh SJ, Tang SC, Hsieh YL, Chen YA, Liu HM, Jeng JS. Validity of Carotid Duplex Sonography in Screening for Intracranial Dural Arteriovenous Fistula among Patients with Pulsatile Tinnitus. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:407-412. [PMID: 26614386 DOI: 10.1016/j.ultrasmedbio.2015.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 10/16/2015] [Accepted: 10/18/2015] [Indexed: 06/05/2023]
Abstract
Pulsatile tinnitus may result from intracranial dural arteriovenous fistula (DAVF), which requires early diagnosis and management. This study validated the role of carotid duplex sonography in screening for DAVF in patients with pulsatile tinnitus. The criteria used for DAVF screening were low resistance index of the external carotid artery or occipital artery (OA). Patients then underwent head magnetic resonance imaging to confirm the diagnosis. Of the 155 patients with pulsatile tinnitus who were prospectively screened, 25 (16.1%) had a low resistance index in either the external carotid artery or occipital artery. All were proven to have DAVF. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value were 96%, 100%, 100% and 98%, respectively. Thus, carotid duplex sonography focusing on low resistance indexes of the external carotid and occipital arteries may be a valuable tool in screening for DAVF in patients with pulsatile tinnitus.
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Affiliation(s)
- Li-Kai Tsai
- Department of Neurology and Stroke Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shin-Joe Yeh
- Department of Neurology and Stroke Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sung-Chun Tang
- Department of Neurology and Stroke Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Lin Hsieh
- Department of Neurology and Stroke Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ying-An Chen
- Department of Neurology and Stroke Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hon-Man Liu
- Department of Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology and Stroke Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Beyond the Bifurcation: There Is More to Cerebrovascular Ultrasound Than Internal Carotid Artery Stenosis! Ultrasound Q 2015; 32:224-40. [PMID: 26588099 DOI: 10.1097/ruq.0000000000000184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Carotid ultrasonography (US) is most commonly performed to identify potential areas of flow-limiting stenosis in the internal carotid artery. Identification of stenosis and unstable plaque is important because these entities are leading predictors of stroke, the fourth most common cause of death in the United States. However, US can detect other important but less common vascular pathologies if proper techniques and nuances of these entities are understood.In this article, we discuss the US appearance of abnormalities involving the carotid, vertebral, subclavian, and innominate arteries as well as the key clinical components of each diagnosis. These include congenital variants, dissection, stenosis, and vasculopathy. In addition, correlation of US findings with both magnetic resonance imaging and computed tomography more comprehensively demonstrates the complementary nature of these imaging modalities.
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Gulati M, Khadem N, Lekht I, Tchelepi H, Grant EG. Subclavian steal following left subclavian artery occlusion during thoracic endovascular aortic repair: Doppler findings and literature review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:926-929. [PMID: 25911727 DOI: 10.7863/ultra.34.5.926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Mittul Gulati
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, California USA
| | - Nasim Khadem
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, California USA
| | - Ilya Lekht
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, California USA
| | - Hisham Tchelepi
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, California USA
| | - Edward G Grant
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, California USA
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Zivadinovic B, Stamenović J, Ljubisavljevic S. The comparative analyses of the auditory evoked potentials and color Doppler sonography findings in patients diagnosed with vertebrobasilar insufficiency. Neurol Res 2014; 36:939-44. [PMID: 24806547 DOI: 10.1179/1743132814y.0000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Auditory evoked potentials (AEP) represent an electrophysiological method used in the diagnostics of pathological changes of the brainstem. Patients with vertebrobasilar insufficiency (VBI) show changes in the AEP-caused ischemia of the brain structures that generate their responses. The aim of the study was to determine the diagnostic significance and correlation among the findings of AEP in patients with VBI established by color Doppler sonography. The cross-sectional and prospective research included 48 inpatients and outpatients treated at the Clinic of Neurology, Clinical Center Nis. Ultrasound Doppler of blood vessels in the neck included an examination of the carotid blood vessels, the outcome and all sonographically available parts of the vertebral artery (VA) with particular emphasis on the intravertebral segment (V2). The morphological and hemodynamic characteristics of VA in this segment were monitored, and it was important to test the systolic velocity in two adjacent intervertebral spaces. Auditory evoked potentials were used to monitor the amplitudes, absolute latencies of waves I, II, III, IV, and V, as well as interwave latencies (IWLs) I-III, III-V, and I-V. There is statistically significant difference in the more frequent pathological finding of AEP in patients with higher degree of the reduced flow of VA established by color Doppler (P < 0.05) compared to patients with less reduction in the flow. Pathological findings of AEP are well correlated with pathological findings of VBI in color Doppler, and it may be applied as an additional and useful marker in diagnosis of VBI.
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Purvis DL, Crutchfield K, Trickey AW, Aldaghlas T, Rizzo A, Sikdar S. Transcranial Doppler investigation of hemodynamic alterations associated with blunt cervical vascular injuries in trauma patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1759-1768. [PMID: 24065257 DOI: 10.7863/ultra.32.10.1759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Blunt cervical vascular injuries, often missed with current screening methods, have substantial morbidity and mortality, and there is a need for improved screening. Elucidation of cerebral hemodynamic alterations may facilitate serial bedside monitoring and improved management. Thus, the objective of this study was to define cerebral flow alterations associated with single blunt cervical vascular injuries using transcranial Doppler sonography and subsequent Doppler waveform analyses in a trauma population. METHODS In this prospective pilot study, patients with suspected blunt cervical vascular injuries had diagnoses by computed tomographic angiography and were examined using transcranial Doppler sonography to define cerebral hemodynamics. Multiple vessel injuries were excluded for this analysis, as the focus was to identify hemodynamic alterations from isolated injuries. The inverse damping factor characterized altered extracranial flow patterns; middle cerebral artery flow velocities, the pulsatility index, and their asymmetries characterized altered intracranial flow patterns. RESULTS Twenty-three trauma patients were evaluated: 4 with single internal carotid artery injuries, 5 with single vertebral artery injuries, and 14 without blunt cervical vascular injuries. All internal carotid artery injuries showed a reduced inverse damping factor in the internal carotid artery and dampened ipsilateral mean flow and peak systolic velocities in the middle cerebral artery. Vertebral artery injuries produced asymmetry of a similar magnitude in the middle cerebral artery mean flow velocity with end-diastolic velocity alterations. CONCLUSIONS These data indicate that extracranial and intracranial hemodynamic alterations occur with internal carotid artery and vertebral artery blunt cervical vascular injuries and can be quantified in the acute injury phase by transcranial Doppler indices. Further study is required to elucidate cerebral flow changes resulting from a single blunt cervical vascular injury, which may guide future management to preserve cerebral perfusion after trauma.
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Affiliation(s)
- Dianna L Purvis
- Department of Bioengineering, George Mason University, 4400 University Dr, MS 1G5, Fairfax, VA 22030 USA.
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FUKUZUMI N, HAMAGUCHI H, KOUSAKA H, OKI T, SAKAMOTO M, IMANISHI T, HAYASHI N, KAWANO S, KANDA F. Ultrasonographic findings of five patients with extracranial vertebral artery dissection. ACTA ACUST UNITED AC 2013. [DOI: 10.2301/neurosonology.26.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Levitt MR, Vaidya SS, Mai JC, Hallam DK, Kim LJ, Ghodke BV. Balloon Test Occlusion with the Doppler Velocity Guidewire. J Stroke Cerebrovasc Dis 2012; 21:909.e1-4. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 10/06/2011] [Accepted: 10/15/2011] [Indexed: 11/30/2022] Open
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Engelhardt E, Tocquer C, André C, Moreira DM, Okamoto IH, Cavalcanti JLDS. Vascular dementia: Diagnostic criteria and supplementary exams. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part I. Dement Neuropsychol 2011; 5:251-263. [PMID: 29213752 PMCID: PMC5619038 DOI: 10.1590/s1980-57642011dn05040003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Vascular dementia (VaD) is the most prevalent form of secondary dementia and the
second most common of all dementias. The present paper aims to define guidelines
on the basic principles for treating patients with suspected VaD (and vascular
cognitive impairment - no dementia) using an evidence-based, systematized
approach. The knowledge used to define these guidelines was retrieved from
searches of several databases (Medline, Scielo, Lilacs) containing scientific
articles, systematic reviews, meta-analyses, largely published within the last
15 years or earlier when pertinent. Information retrieved and selected for
relevance was used to analyze diagnostic criteria and to propose a diagnostic
system encompassing diagnostic criteria, anamnesis, as well as supplementary and
clinical exams (neuroimaging and laboratory). Wherever possible, instruments
were selected that had versions previously adapted and validated for use in
Brazil that take into account both schooling and age. This task led to proposed
protocols for supplementary exams based on degree of priority, for application
in clinical practice and research settings.
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Affiliation(s)
- Eliasz Engelhardt
- Full Professor (retired) - UFRJ, Coordinator of the Cognitive Neurology and Behavior Sector, INDC, CDA/IPUB, UFRJ, Rio de Janeiro RJ, Brazil
| | - Carla Tocquer
- Neurologist, Masters and PhD in Neuropsychology, Claude Bernard University, France
| | - Charles André
- Associate Professor of Neurology, Faculty of Medicine, UFRJ. Medical Director of SINAPSE Rehabilitation and Neurophysiology, Rio de Janeiro RJ, Brazil
| | - Denise Madeira Moreira
- Adjunct Professor of Radiology, School of Medicine, UFRJ. Head of Radiology Sector, INDC, UFRJ, Rio de Janeiro RJ, Brazil
| | - Ivan Hideyo Okamoto
- Department of Neurology Neurosurgery, UNIFESP, Institute of Memory, UNIFESP, São Paulo SP, Brazil
| | - José Luiz de Sá Cavalcanti
- Adjunct Professor of Neurology, INDC, UFRJ. Cognitive Neurology and Behavior Sector, INDC, UFRJ, Rio de Janeiro RJ, Brazil
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17
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Abstract
Duplex sonography of extracranial arteries is one of the best tools for identifying stenoses and other diseases of the carotid, vertebral, and subclavian arteries. Abnormal Doppler waveforms in vertebral arteries could be evidence of subclavian steal syndrome. The difference of 15 to 20 mm Hg or more in systolic bilateral brachial arterial blood pressure measurements provides important clinical information in patients with subclavian steal syndrome. Complementary to duplex sonographic scanning, radiologists use computerized tomography angiography, magnetic resonance angiography, and digital subtraction angiography for preoperative planning.
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