Cerebrovascular Ultrasound in Stroke Prevention and Treatment (eBook)

Andrei V. Alexandrov, MD, RVT Assistant Professor of Neurology and Radiology Director, STAT Neurosonology Service and Center for Noninvasive Brain Perfusion Studies Stroke Program, University of Texas-Houston Medical School Houston, TX

Cerebrovascular Ultrasound in Stroke Prevention and Treatment 5
Contents 7
Contributors 9
Foreword: Ultrasound: a clinician’s perspective 11
Preface 13
Acknowledgements 14
Part I How to perform ultrasound tests 15
1 Cerebrovascular anatomy and principles of extracranial ultrasound examination 17
2 Intracranial cerebrovascular ultrasound examination techniques 31
3 Color flow anatomy of the circle of Willis 47
Part II Hemodynamic principles 53
4 Integrated assessment of systemic and intracranial hemodynamics 55
5 Practical models of cerebral hemodynamics and waveform recognition 76
Part III Criteria for interpretation 93
6 Diagnostic criteria for cerebrovascular ultrasound 95
Part IV Ultrasound in stroke prevention and treatment 145
7 TCD and sickle cell disease 147
8 Cardiovascular risk factors and carotid ultrasound 162
9 Carotid and vertebral duplex scanning in secondary stroke prevention and stenting 175
10 Acute ischemic stroke 184
11 Cerebral vasospasm after subarachnoid hemorrhage 195
Part V Select clinical applications and clinical vignettes 203
Typical MCA/TICA vasospasm after subarachnoid hemorrhage 205
Bilateral ACA vasospasm after subarachnoid hemorrhage 209
Multiple vessel vasospasm after subarachnoid hemorrhage 212
Cerebral circulatory arrest 217
Anatomic variation or a hemodynamically significant lesion? 220
Subclavian steal 224
Carotid dissection 227
Carotid thromboembolism 231
Monitoring carotid endarterectomy 234
Brain retroperfusion 241
MCA stenosis 245
Acute tandem occlusion 251
Arterial recanalization and dramatic recovery from stroke 256
Arterial reocclusion and deterioration following improvement 265
Extended window for thrombolysis 270
Index 275

Review of the textbook

"Cerebrovascular Ultrasound in Stroke prevention andTreatment" Edited by Andrei V. Alexandrov

Assistant Professor of Neurology and Radiology, Director, STATNeurosonology Service and Center for Non-invasive Brain PerfusionStudies Stroke Program, University of Texas-Houston Medical SchoolHouston Texas

First Edition, 2004. 267 pages. Blackwell Publishingwww.blackwellpublishing.com, www.blackwellfutura.com

This book has been produced by an international team ofcontributors, edited at the University of Texas and is aimed atthree types of individuals: beginners to learn the basics ofultrasound testing, advanced users to learn differential diagnosisand clinicians involved in treating stroke patients. The text ispacked full of useful practical information and has excellentillustrations and TCD images. However, the content is not basic andbeginners wishing to start TCD would be advised to read simplertexts prior to this book. It is divided into five parts: Part I-Howto perform ultrasound tests covers both extracranial andintracranial ultrasound examination with an emphasis onstandardisation for carotid duplex. The techniques for carrying outsingle-gated spectra (TCD), power-motion Doppler (M-mode) andtranscranial colour duplex imaging (TCCS) are outlined in a simpleand clear manner. The advantages of M-mode (easier window-finding)and TCCS (identifying anomalies of the circle of Willis) for thebeginner are emphasised but the caveat for both M-mode and TCCS isspectral resolution and it is acknowledged that experiencedoperators will still use single-gated TCD. Part II-Haemodynamicprinciples is a "heavy" section but will be ofparticular interest to anyone working in the intensivecare/surgical setting. The chapter on practical models of cerebralhaemodynamics importantly emphasises spectral waveform recognitionrather than the usual emphasis on velocity. Part III-Criteria forinterpretation. is an excellent section covering diagnostic andvalidation criteria for carotid stenosis, carotid and vertebralartery dissection and occlusion, intracerebral arterial vasospasm,embolism detection, with a good description of the TIBI ultrasoundclassification for large vessel occlusion. Part IV-Ultrasoundin stroke prevention and treatment covers ultrasound findings ofspecific diseases including sickle cell disease, cardiovascularrisk, secondary stroke prevention, acute ischaemic stroke,subarachnoid haemorrhage. The chapter on ischaemic stroke discussesthe potential therapeutic use of TCD and is well worth reading.Part V-Select clinical applications and clinical vignettesincludes an interesting collection of anecdotal vascular casescovering areas, which can give diagnostic difficulty. The excitingparts of this book have to be the emphasis on the potentialtherapeutic use of diagnostic TCD and the focus on waveformanalysis rather than velocity measurements. This opens up TCD as abedside tool, which will hopefully mean that more clinicians willstart using this powerful technique.

Dr Paul Syme

Consultant Physician

Lead Stroke Physician NHS Borders

Part-time Senior lecturer University of Edinburgh