Evaluation of Contrast-enhanced Transcranial Color-coded Duplex Sonography (CE-TCCD) Applied in Stroke Patients with Intracranial Collateral Circulation

Page: [887 - 891] Pages: 5

  • * (Excluding Mailing and Handling)

Abstract

Background and Introduction: Collateral circulation is very crucial for the prognosis of stroke patients. Transcranial color-coded duplexsonography (TCCD) is used widely to evaluate the intracranial arterial blood flow. However, approximately 20% - 30% of the patients with cerebral infarction cannot be detected via TCCD due to the interruption of thickened temporal bones. We assessed the diagnostic efficacy of contrast-enhanced transcranial color-coded duplexsonography (CE-TCCD) in stroke patients with limited bone windows.

Methods: CE-TCCD was applied to 70 patients (51 males and 19 females) who presented with ischemic symptoms, to detect the openness of the anterior communicating artery (ACoA) and posterior communicating artery (PCoA) of the Willis ring before Computed Tomography angiography (CTA) or Magnetic Resonance Angiography (MRA) examination. The results from CETCCD is used to compare with CTA/MRA result to verify the diagnostic efficacy.

Results: Forty-one communicating artery openings were detected by CE-TCCD, among which 37 were PCoA and 4 were ACoA. Among the 70 patients, 23 of 70 patients indicated severe stenosis within intracranial and/or extracranial arteries. Eighteen out of the 23 patients showed collateral circulation, accounting for 78.3% (18/23). Moderate stenosis were 23 cases in total, in which 7 cases showed collateral circulation, accounting for 30.4% (7/23). Slight stenosis were 24 cases in total, none of which showed collateral circulation.

Conclusion: In the stroke patients with limited bone windows, CE-TCCD can evaluate intracranial collateral circulation.

Keywords: Ultrasonography, contrast, cerebral ischemia, stroke, collateral circulation, wills ring.

Graphical Abstract

[1]
Chuang YM, Chan L, Lai YJ, et al. Configuration of the circle of Willis is associated with less symptomatic intracerebral hemorrhage in ischemic stroke patients treated with intravenous thrombolysis. J Crit Care 2013; 28(2): 166-72.
[http://dx.doi.org/10.1016/j.jcrc.2012.08.018] [PMID: 23102529]
[2]
Christoforidis GA, Mohammad Y, Kehagias D, Avutu B, Slivka AP. Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke. AJNR Am J Neuroradiol 2005; 26(7): 1789-97.
[PMID: 16091531]
[3]
Liebeskind DS, Cotsonis GA, Saver JL, et al. Collaterals dramatically alter stroke risk in intracranial atherosclerosis. Ann Neurol 2011; 69(6): 963-74.
[http://dx.doi.org/10.1002/ana.22354] [PMID: 21437932]
[4]
Liebeskind DS. Collateral circulation. Stroke 2003; 34(9): 2279-84.
[http://dx.doi.org/10.1161/01.STR.0000086465.41263.06] [PMID: 12881609]
[5]
Siddiqui AH, Chen PR. Intracranial collateral anastomose relevance to endovascular procedures. Neurosurg Clin N Am 2009; 20(3): 279-96.
[6]
Li Q, Li J, Lv F, Li K, Luo T, Xie P. A multidetector CT angiography study of variations in the circle of Willis in a Chinese population. J Clin Neurosci 2011; 18(3): 379-83.
[http://dx.doi.org/10.1016/j.jocn.2010.07.137] [PMID: 21251838]
[7]
Gahn G, Gerber J, Hallmeyer S, et al. Contrast-enhanced transcranial color-coded duplexsonography in stroke patients with limited bone windows. AJNR Am J Neuroradiol 2000; 21(3): 509-14.
[PMID: 10730643]
[8]
Kern R, Szabo K, Hennerici M, Meairs S. Characterization of carotid artery plaques using real-time compound B-mode ultrasound. Stroke 2004; 35(4): 870-5.
[http://dx.doi.org/10.1161/01.STR.0000120728.72958.4A] [PMID: 15001797]
[9]
Ferrara KW, Merritt CR, Burns PN, Foster FS, Mattrey RF, Wickline SA. Evaluation of tumor angiogenesis with US: imaging, Doppler, and contrast agents. Acad Radiol 2000; 7(10): 824-39.
[http://dx.doi.org/10.1016/S1076-6332(00)80631-5] [PMID: 11048880]
[10]
Baumgartner RW, Mattle HP, Schroth G. Assessment of >/=50% and <50% intracranial stenoses by transcranial color-coded duplex sonography. Stroke 1999; 30(1): 87-92.
[http://dx.doi.org/10.1161/01.STR.30.1.87] [PMID: 9880394]
[11]
Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI. A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 2000; 21(4): 643-6.
[PMID: 10782772]
[12]
Miteff F, Levi CR, Bateman GA, Spratt N, McElduff P, Parsons MW. The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke. Brain 2009; 132(Pt 8): 2231-8.
[http://dx.doi.org/10.1093/brain/awp155] [PMID: 19509116]
[13]
Bang OY, Saver JL, Kim SJ, et al. Collateral flow predicts response to endovascular therapy for acute ischemic stroke. Stroke 2011; 42(3): 693-9.
[http://dx.doi.org/10.1161/STROKEAHA.110.595256] [PMID: 21233472]
[14]
Bang OY, Saver JL, Kim SJ, et al. Collateral flow averts hemorrhagic transformation after endovascular therapy for acute ischemic stroke. Stroke 2011; 42(8): 2235-9.
[http://dx.doi.org/10.1161/STROKEAHA.110.604603] [PMID: 21737798]
[15]
Ganau M, Ligarotti GK, Apostolopoulos V. Real-time intraoperative ultrasound in brain surgery: neuronavigation and use of contrast-enhanced image fusion. Quant Imaging Med Surg 2019; 9(3): 350-8.
[http://dx.doi.org/10.21037/qims.2019.03.06] [PMID: 31032183]