Transcranial color-coded duplex sonography implication for verification of extracranial-intracranial bypass patency in case of chronic internal carotid artery occlusion
EANS Academy. Nemirovskiy A. 09/27/19; 275966; EP01125
Dr. Alexander Nemirovskiy
Dr. Alexander Nemirovskiy

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Extracranial-intracranial bypass (ECIC) surgery has been performed for internal carotid artery (ICA) occlusion, associated with brain misery perfusion. Besides clinical aspects, accurate assessment of applied bypass patency within early post-operation period is considered to be the cornerstone of successive intervention.
Aim: To demonstrate our clinic experience of transcranial color-coded duplex sonography (TCCD) application for confirmation of bypass patency following ECIC bypass application.
Material and methods: Post-hoc assessment of medical records for 35 patients treated in our institution has been performed.
Diagnostic procedure was performed on Loqic E9 (GE, HC, USA) machine with lineal sensor L9 in color-coded doppler carting (CCDC) in B-flow and PW-mode.
The sensor was located adjacent to anastomotic area anteriorly and superiorly to the tragus within superficial temporal artery projection. Functioning bypass was fully-colored with arterial flow pattern and lineal flow velocity 30 to 50 cm/msec.
There was an opportunity for assessment of flow velocity and direction both extracranially and intracranially.
Results and discussion: From 2008 until now 225 interventions with low flow ECIC bypass have been performed in our institution in patients with chronic unilateral (199) and bilateral (26) ICA occlusion.
TCCD has been utilized for ECIC bypass patency assessment since 2016. This instrumental technique was applied in 34 cases. Functioning ECIC bypass was confirmed in 29 cases with doubtful interpretation in 3 cases and of absent blood flow through anastomosis area in 2 cases.
TCCD is a cost effective method (more affordable compared to either digital selective angiography, or cerebral CT-angiorgrapy) without any hazard to the patient. TCCD is not associated with radiation emittion and no contrast agent injection is required for the procedure. It is convenient for multiple follow up examinations in different time points.
Conclusion: Transcranial color-coded duplex sonography is considered to be informative and comprehensible method for verification of ECIC bypass patency.
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