Intracranial vessel localization with power motion Doppler (PMD-TCD) compared with CT angiography in patients with acute ischaemic stroke
- Conflict of interest: Kristian Barlinn is supported through NINDS SPOTRIAS grant (PI – James Grotta, MD, University of Texas-Houston), project CLOTBUST-Hands Free, a phase II study of an operator-independent device for sonothrombolysis in stroke. Andrei Alexandrov serves as consultant to Cerevast Therapeutics, Inc. and holds a US patent 6733450 ‘Therapeutic Method and Apparatus for Use of Sonication to Enhance Perfusion of Tissues’, assignee – Texas Board of Regents.
- The other co-authors have no disclosures.
Correspondence: Andrei V. Alexandrov*, Department of Neurology, Comprehensive Stroke Center, The University of Alabama at Birmingham, RWUH M226, 619 19th Street South, Birmingham, AL 35249-3280, USA.
With a view to develop an operator-independent monitoring system for sonothrombolysis, we aimed to evaluate the per cent agreement of power motion transcranial Doppler vessel tracks compared with computed tomography angiography in identification of the anterior and posterior circulation vessels in patients with acute ischaemic stroke.
Consecutive acute ischaemic stroke patients who underwent emergent brain computed tomography angiography and bedside power motion transcranial Doppler were studied. Depth ranges for detecting anterior and posterior circulation vessels were derived from power motion transcranial Doppler flow tracks and computed tomography angiography images of the circle of Willis. We calculated percent agreement of power motion transcranial Doppler with computed tomography angiography for the anterior and posterior circulation vessel localization using computed tomography angiography as reference.
Samples were obtained from 34 acute ischaemic stroke patients (mean age 61 ± 16 years, 62% men, median National Institutes of Health Stroke Scale (NIHSS) score 5, interquartile range 2–8). A total of 229 Power motion Doppler computed tomography angiography vessel pairs were analysed. Power motion transcranial Doppler tracks for M1 and proximal M2 middle cerebral artery (MCA) were located at 24–68 mm (M1 MCA: 36–68 mm; M2 MCA: 24–53 mm); anterior cerebral artery (ACA): 50–78 mm; P1 posterior cerebral artery (PCA): 50–74 mm; left vertebral artery: 30–74 mm; right vertebral artery: 30–78 mm; basilar artery: 76–106 mm. The per cent agreement of power motion Doppler-transcranial Doppler for identifying proximal intracranial arteries compared to computed tomography angiography was: M1 and M2 MCA: 100% (95% confidence interval: 96–100%); M1 MCA: 98% (95% confidence interval: 86–100%); M2 MCA: 94% (95% confidence interval: 79–99%); A1 ACA: 82% (95% confidence interval: 68–91%); P1 PCA: 70% (95% confidence interval: 53–83%); left vertebral artery: 96% (95% confidence interval: 80–100%); right vertebral artery: 96% (95% confidence interval: 79–100%); basilar artery: 100% (95% confidence interval: 89–100%).
Power motion transcranial Doppler intercepts proximal vessels with good-to-excellent agreement with computed tomography angiography. Depth ranges (as opposed to average depths) can be used to target intracranial arterial segments for sonothrombolysis.