title: The Presto 1000: A novel automated transcranial Doppler ultrasound system.
abstract: We examined the reliability and ease of use of a novel automated transcranial Doppler (TCD) system in comparison to a conventional TCD system. TCD ultrasound allows non-invasive monitoring of cerebral blood flow, and can predict arterial vasospasm after a subarachnoid hemorrhage (SAH). The Presto 1000 TCD system (PhysioSonics, Bellevue, WA, USA) is designed for monitoring flow through the M1 segment of the middle cerebral artery (MCA) via temporal windows. The Presto 1000 system was tested across multiple preclinical and clinical settings in parallel with a control predicate TCD system. In a phantom flow generating device, both the Presto 1000 and Spencer system (Spencer Technologies, Redmond, WA, USA) were able to detect velocities with high accuracy. In nine volunteer patients, the Presto system was able to locate the MCA in 14 out of 18 temporal windows, in an average of 12.5s. In the SAH cohort of five patients with a total of 25 paired measurements, the mean absolute difference in flow velocities of the M1 segment, as measured by the two systems, was 17.5 cm/s. These data suggest that the Presto system offers an automated TCD that can reliably localize and detect flow of the MCA, with relative ease of use. The system carries the additional benefit of requiring minimal training for the operator, and can be used by many providers across multiple bedside settings. The mean velocities that were generated warrant further validation across an extended group of patients, and the predictive value for vasospasm should be checked against the current standard of angiography.
authors.affiliation: Department of Neurological Surgery, University of California, 505 Parnassus Avenue, M-779, San Francisco, CA 94143, USA. Electronic address: Seunggu.han@ucsf.edu.
authors.forename: Seunggu J
authors.initials: SJ
authors.lastname: Han
authors.affiliation: Department of Neurological Surgery, University of California, 505 Parnassus Avenue, M-779, San Francisco, CA 94143, USA.
authors.forename: William Caleb
authors.initials: WC
authors.lastname: Rutledge
authors.affiliation: Department of Neurological Surgery, University of California, 505 Parnassus Avenue, M-779, San Francisco, CA 94143, USA.
authors.forename: Dario J
authors.initials: DJ
authors.lastname: Englot
authors.affiliation: Department of Neurological Surgery, University of California, 505 Parnassus Avenue, M-779, San Francisco, CA 94143, USA.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Winkler
authors.affiliation: Vascular Laboratory, University of California, San Francisco, CA, USA.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Browne
authors.affiliation: Verasonics Incorporated, Kirkland, WA, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Pflugrath
authors.affiliation: PhysioSonics Incorporated, Bellevue, WA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Cronsier
authors.affiliation: Department of Neurological Surgery, University of Arkansas, Little Rock, AR, USA.
authors.forename: Adib A
authors.initials: AA
authors.lastname: Abla
authors.affiliation: PhysioSonics Incorporated, Bellevue, WA, USA; Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kliot
authors.affiliation: Department of Neurological Surgery, University of California, 505 Parnassus Avenue, M-779, San Francisco, CA 94143, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lawton
mesh_terms: D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D017585:Ultrasonography, Doppler, Transcranial
keywords: Automated; Middle cerebral artery; Subarachnoid hemorrhage; Transcranial Doppler; Vasospasm; Velocity