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Vasospasm monitoring of the basilar artery with image-guided transcranial Doppler sonography - a single center feasibility study
EANS Academy. Stein M. Sep 27, 2019; 276081; EP12062
Abstract
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Background: Similar to its application to the middle cerebral artery (MCA), transcranial Doppler sonography (TCD) can also be used in diagnostics of vasospasm of the basilar artery (BA) in patients with subarachnoid hemorrhage (SAH). However, TCD of the BA is challenging and requires a higher level of experience. The aim of this study was to test the feasibility of the use of image guidance to perform image-guided TCD exams of the BA in SAH patients.
Methods: SAH patients who had undergone computed tomography angiography (CTA) were included. CTA Dicom data were taken to generate a treatment plan and used to perform serial image guided TCD exams of proximal and distal BA, vertebral arteries (VA), MCA, anterior and posterior cerebral arteries (ACA, PCA). Spatial precision was determined by analyzing the distance between preplanned vascular target and the position of optimal Doppler signal.
Results: 10 patients were included, all of who received 5 serial TCD exams. In all patients, TCD examination of all predefined supra- and infratentorial vessel segments were possible. The deviation between preplanned position and optimal Doppler signal representing spatial precision for BA (6.3±3.0 mm) was larger compared to left VA (4.1±2.2 mm), right VA (4.6±1.1 mm), and supratentorial vessels (4.8±1.9 mm). Furthermore, the deviation between the optimal Doppler signal at the first exam and the following serial exams for BA (6.9±3.5 mm), left VA (4.4±1.9 mm) and right VA (4.9±1.9 mm) were larger compared to the supratentorial vessels (3.3±1.7 mm).
Conclusions: Image-guided TCD of the BA is feasible and facilitates TCD examinations of posterior fossa vessels. Although its spatial accuracy was lower compared to examination of supratentorial vascular targets, it is sufficient to perform precise and reproducible TCD examinations of the infatentorial vessels in the setting of vasospasm monitoring after SAH.
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