title: Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia.
abstract: OBJECTIVE
  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, > or =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 > or =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.
authors.affiliation: Stroke Treatment Team, University of Texas-Houston, Texas 77005, USA.
authors.forename: Oleg Y
authors.initials: OY
authors.lastname: Chernyshev
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Garami
authors.forename: Sergio
authors.initials: S
authors.lastname: Calleja
authors.forename: Joon
authors.initials: J
authors.lastname: Song
authors.forename: Morgan S
authors.initials: MS
authors.lastname: Campbell
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Noser
authors.forename: Hashem
authors.initials: H
authors.lastname: Shaltoni
authors.forename: Chin-I
authors.initials: CI
authors.lastname: Chen
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Iguchi
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D000208:Acute Disease; D000368:Aged; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000000981:diagnostic imaging; D008297:Male; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D018616:Ultrasonography, Doppler, Duplex; D017585:Ultrasonography, Doppler, Transcranial