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Color Doppler of the extracranial and intracranial arteries in the acute phase of cerebral ischemia

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Abstract

Vascular imaging greatly improves the possibility of locating the site of vascular occlusion in patients with acute cerebrovascular disease. Different occlusive patterns may underlie the same clinical presentation, with different prognosis and different treatment: for this reason, a diagnostic tool able to identify quickly the status of the extra- and intracranial vessels is needed. Color Doppler ultrasound of the extracranial arteries is a reliable and accurate method able to localize and quantify the carotid artery stenosis. The ultrasound quantification of the degree of stenosis is based on both morphological and velocimetric criteria: B-mode, color or power Doppler and spectral analysis are used for this purpose. Also the analysis of the plaque is an integral part of the ultrasound examination: the B mode plaque characterization (structure and surface) plays an important role in the evaluation of risk of stroke. So color Doppler ultrasound is able to select patients who may require medical therapy, carotid endarterectomy or angioplasty and stenting. Transcranial color Doppler is an inexpensive, reliable, fast, non-invasive, bedside tool: in the acute phase of stroke, it is able to evaluate quickly the intracranial arteries and monitor the possible recanalization of occluded vessel ensuring the follow-up of dynamic lesions, such as the intracranial stenosis and occlusions.

Riassunto

L'imaging dei vasi extra e intracranici, nei pazienti con insufficienza cerebrovascolare acuta, migliora notevolmente la possibilità di localizzare la sede dell'eventuale occlusione vascolare. Infatti, differenti patterns occlusivi possono comportare una medesima presentazione clinica dello stroke, ma con diversa prognosi e diverso trattamento: per questo motivo è necessario uno strumento diagnostico in grado di identificare rapidamente lo stato dei vasi extra e intracranici. L'eco-color-Doppler delle arterie extracraniche è un metodo affidabile e preciso in grado di localizzare e quantificare la stenosi carotidea. La quantificazione ecografica del grado di stenosi è basata su criteri morfologici e velocitometrici: per questo scopo sono utilizzati il B mode, il color/power Doppler e l'analisi spettrale. Anche l'analisi della placca è parte integrante dell'esame ecografico: la caratterizzazione ultrasonografica della placca (struttura e superficie) svolge, infatti, unruolo importante nella valutazione del rischio di stroke. In questo modo lo studio ultrasonografico delle arterie extracraniche è in grado di selezionare i pazienti che necessitano di terapia medica, di endoarteriectomia carotidea o di angioplastica/stenting. Il transcranial-color-Doppler è uno strumento affidabile, non invasivo, ripetibile, eseguibile al letto del paziente: nella fase acuta dello stroke è in grado di valutare rapidamente le arterie intracraniche e monitorare l'eventuale ricanalizzazione del vaso occluso garantendo il follow-up di lesioni dinamiche quali le stenosi e ostruzioni intracraniche.

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Conflict of interest

Franco Accorsi declares that he has no conflict of interest.

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All patients provided written informed consent.

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All procedures followed in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5).

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  1. Independent professional in the areas of angiology and vascular diagnostics, Bologna, Italy

    Franco Accorsi

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  1. Franco Accorsi
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Correspondence to Franco Accorsi.

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Accorsi, F. Color Doppler of the extracranial and intracranial arteries in the acute phase of cerebral ischemia. J Ultrasound 16, 187–193 (2013). https://doi.org/10.1007/s40477-013-0036-7

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  • DOI: https://doi.org/10.1007/s40477-013-0036-7

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