• Utilidad del doppler transcraneal en la detección del vasoespamo

    La vasoconstricción temprana o tardía de las arterias intracraneales ocurre en distintas situaciones (HSA, por fármacos, TCE, etc). Se ha demostrado una correlación significativa entre la severidad del vasoespasmo secundario a HSA espontánea y las velocidades del flujo intracraneal de la ACM. Velocidades sistólicas pico mas de 200 cms/seg o un índice de Lindegaard (Vel ACM / Vel ACI) de 6 ± 0.3 predice con fiabilidad la presencia de vasoespasmo angiográfico clínicamente significativo (Lysakowski C et al; 2001). Estimaciones cuantitativas para detectar vasoespasmo de otras arterias de la circulación anterior (ACA, TICA, ACP) han sido propuestas pero no han sido validadas fiablemente. Para poder interpretar los hallazgos por DTC que sugieren vasoespasmo se debe tener en cuenta factores técnicos, la presión intracraneal, y factores hemodinámicos sistémicos (Tensión arterial media, hematocrito, etc). Otra de las utilidades del DTC es la posibilidad de monitorizar el vasoespasmo de forma continua y hacer un seguimiento diario que nos permite valorar el efecto y la durabilidad de tratamientos neurointervencionistas en tiempo real. De hecho, el DTC ha sido probado para la detección de vasoespasmo angiográfico tras angioplastia con balón en pacientes de alto riesgo, o en pacientes sometidos a tratamientos farmacológicos vasodilatadores y para valorar la respuesta farmacológica en pacientes con eclampsia y HSA (Haley et al; 1993, Naidu et al; 1996, Findlay JM; 1993).469 TABLAC~1.JPGBIBLIOGRAFÍA• Aaslid R, Markwalder TM, Nornes H (1982). Noninvasive transcranial doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg. 57:769-74.• Adams RJ, McKie VC, Carl ME, Nichols FT, Perry R, Brock K, et al (1997). Long Term stroke risk in children with sickle cell disease screened with transcranial Doppler. Ann Neurol. 43: 699-704.• Adams RJ, McKie VC, Hsu L, Files B, Vichinsky E, Pegelow C, et al (1998). Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 339: 5-11.• Akdemir H, Oktem S, Menku A, Tucer B, Tuğcu B, Günaldi O. (2007). Image-guided microneurosurgical management of small arteriovenous malformations: role of neuronavigation and intraoperative Doppler sonography. Minim Invasive Neurosurg. 50: 163-69.• Alexandrov AV(ed.). (2004a) Cerebrovascular Ultrasound in Stroke Prevention and Treatment. New York: Futura/Blackwell Publishing.• Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-Sabin J, et al (2004b). Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med. 351(21):2170-8.• Alexandrov AV, Burgin WS, Demchuk AM, El-Mitwalli A, Grotta JC (2001). Speed of intracranial clot lysis with intravenous tPA therapy: Sonographic classification and short term improvement. Circulation. 103: 2897-902.• Alexandrov AV, Demchuk AM, Wein TH, Grotta JC.(1999). Yield of transcranial Doppler in acute cerebral ischemia. Stroke. 30: 1604-1609.• Alexandrov AV, Grotta JC (2002). Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator. Neurology. 59: 862-7.• Alexandrov AV, Sloan MA, Wong LKS, Douville C, Razumovsky A, Koroshetz W, et al. (2007). Practice Standards for transcranial Doppler Ultrasound: Part I-Test Performance. J Neuroimaging. 17: 11-18.• Babikian VL, Cantelmo NL, Wijman CAC (1999). Neurovascular monitoring during carotid endarterectomy. En: Babikian VL, Wechsler LR, eds. Transcranial Doppler sonography. (pp 231-245) 2da ed. Boston: Butterworth-Heineman.• Bailes JE, Tantuwaya LS, Fukushima T, Shurman GW, Davis D. (1997). Intraoperative microvascular Doppler sonography in aneurism surgery. Neurosurg. 40: 965-72.• Barbut D, Yao FS, Hager DN, Kavanaugh P, Trifiletti RR, Gold JP. (1996). Comparison of transcranial Doppler ultrasonography and transesophageal echocardiography to monitor emboli during coronary artery bypass surgery. Stroke. 27: 87-90.• Brunser A, Lavados PM, Hoppe A, López J, Valenzuela M, Rivas R.(2009). Accuracy of trnascranial Doppler compared with CT angiography in dignosing arterial obstructions in acute ischemic strokes. Stroke. 40: 2037-41.• Cabanes L, Mas JL, Cohen A, Amarenco P, Cabanes PA, Oubary P,et al (1993). Atrial Septal aneurism and patent foramen oval as risk factors for cryptogenic stroke in patients less than 55 years of age: a study using transesophageal echocardiography. Stroke. 24: 1865-73.• Christou I, Felberg E, Demchuk AM, Grotta JC, Burgin WS, Malkoff M et al (2001). A broad diagnostic battery for bedside transcranial Doppler to detect flow changes with internal carotid artery stenosis or occlusion. J Neuroimag. 11: 236-42.• Demchuk AM, Burgin WS, Christou I, Felberg RA, Barber PA, Hill MD, et al.(2001). Thrombolysis in Brain ischemia (TIBI) transcranial Doppler flow grades predict clearly recovery and mortality in patients treated with tissue plasminogen activator. Stroke. 32: 89-93.• Ducrocq X, Hassler H, Moritake K, Newell DW, von Reutern GM, Shiogai T, n cc<et al.(1998). Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler-sonography. J Neurol Sci. 159: 145-50.• Edmonds HL (2001). Advances in neuromonitoring for cardiothoracic and vascular surgery. J Cardiothorac Vasc Anesth. 15: 241-50.• Edmonds HL, Isley MR, Sloan TB, Alexandrov AV, Razumovsky AY (2010). American society of Neurophysiologic Monitoring and American Society of Neuroimaging Joint Guidelines for Transcranial Doppler Ultrasonic Monitoring. J Neuroimaging. XX: 1-7. epub ahead of print.• Findlay JM, Kassell NF, Weir BK, Haley EC Jr, Kongable G, Germanson T, et al. (1995). A randomized trial of intraoperative, intracisternal tissue plasminogen activator for the prevention of vasospasm. Neurosurgery. 37: 168-78.• Gaunt ME, Martin PJ, Smith JL, Rimmer T, Cherryman G, Ratliff DA, et al. (1994). Clinical relevance of intraoperative embolization detected by transcranial Doppler ultrasonography during carotid endarterectomy: a prospective study of 100 patients. Br J Surg. 81: 1435-39.• Gauss M,, Zanette E. (2000). Detection of Right-to-Left Shunt with Ultrasound Contrast Agent and Transcranial Doppler Sonography. Cerebrovasc Dis. 10: 490-96.• Haley EC, Kassell NF, Torner JC. (1993). A randomized controlled trial of intravenous nicardipine in subarachnoid hemorrhage: angiographic and transcranial Doppler ultrasound results. J Neurosurg. 78: 548-53.• Hassler W, Steinmetz H, Pirschel J (1989). Transcranial Doppler study of intracranial circulatory arrest. J Neurosurg. 71: 195-201.• Holzer K, Sadikovic S, Esposito L, Bockelbrink A, Sander D, Hemmer B, et al. (2009). Transcranial Doppler Ultrasonography predicts cardiovascular events after TIA. BMC Medical Imaging. 9:13.• Levi CR, O´Malley HM, Fell G, Roberts AK, Hoare MC, Royle JP, et al.(1997). Transcranial Doppler detected cerebral microembolism following carotid endarterectomy . High micromebolic signals load predicts postoperative cerebral ischemia. Brain. 120: 621-29.• Lupetin AR, Davis DA, Beckman I, Dash N (1995). Transcranial Doppler Sonography. Radiographics. 15: 179-91.• Lysakowski C, Walter B, Costanza MC, Tramer MR (2001). Transcranial Doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm: a systematic review. Stroke. 32: 2292-98.• Martínez-Sánchez P, Tsivgoulis G, Lao A, Sharma V, Alexandrov A.V (2009). El Ultrasonido en la Isquemia Cerebral Aguda. Neurología. 24: 59-68.• Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G,et al (2001). Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurism, or both. N Engl J Med. 345: 1740-46.• McCarthy RJ (2001). The value of transcranial Doppler in predicting cerebral ischemia during carotid endarterectomy. Eur J Vasc Endovasc Surg. 21: 408-12.• Medina-Báez J, Martínez-Sánchez P, Oliva Navarro J, Cazorla R, Ruíz-Ares, G, Fuentes B, et al (2010). Yield of Echocardiography in Right-to-left Shunt detection. Cerebrovasc Dis (Suppl 1): 1-66.• Molina C, Serena J, Álvarez-Sabin J (2000). En: Manual de Doppler Transcraneal. Eds. C Molina, J Serena y T. Segura. Madrid: Ediciones Aula Médica.• Molina CA, Ribo M, Rubiera M, Montaner J, Santamarina E, Delgado-Mederos R, et al.(2006). Microbubble administration accelerates clot lysis during continous 2-MHz ultrasound monitoring in stroke patients treated with intravenous tissue plasminogen activator. Stroke. 37: 425-29.• Molins A, Serena J, Genis D, Bassaganyas J, Pérez-Ayuso MJ, Dávalos A (1996). Utilidad del doppler transcraneal con contraste para el diagnóstico de la comunicación derecha-izquierda en el infarto cerebral de adultos jóvenes.Neurología. 11(6): 205-9.• Naidu S, Payne AJ, Moodley J, Hoffman M, Gouws E. (1996). Randomized study assessing the effect of phenytoin and magnesium sulphate on maternal cerebral circulation in eclampsia using transcranial Doppler ultrasound. Br J Obstet Gynaecol. 103: 111-16.• Navarro JC, Lao AY, Sharma VK, Tsivgoulis G, Alexandrov AV (2007). The accuracy of transcranial Doppler in the diagnosis of middle cerebral artery stenosis. 23: 325-330.• Nornes H, Grip A, Wikeby P (1979). Intraoperative evaluationof cerebral hemodynamics using direccional doppler technique. I. Arteriovenous malformations. J Neurosurg. 50:145-151.• Petty GW, Mohr JP, Pedley TA, et al (1990). The role of transcranial Doppler in confirming brain death. Neurology. 40: 300-3.• Ratsep T, Asser T (2001). Cerebral hemodynamics impairment after aneurismal subarachnoid hemorrhage as evaluated using transcranial Doppler ultrasonography: relationship to delayed cerebral ischemia and clinical outcome. J Neurosurg. 95: 393-401.• Ringelstein EB, Droste DW, Babikian WL, Evans DH, Grosset DG, Kaps M,et al (1998). Consensus on microembolous detection by TCD. Stroke. 29:725-29.• Saqqur M, Uchino K, Demchuk AM, Molina CA, Garami Z, Calleja S, et al (2007). Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke. 38: 948-54.• Schwarze JJ, Babikian VL, DeWitt LD, Sloan MA, Wechsler LR, Gomez CR, et al.(1994) Longitudinal monitoring of intracranial arterial stenoses with transcranial Doppler ultrasonography.4:182-7.• Sharma VK, Tsivgoulis G, Lao A, Malkoff MD, Alexandrov AV (2007). Noninvasive detection of diffuse intracranial disease. Stroke. 38: 3175-81.• Sloan MA, Alexandrov AV, Tegeler CH, Spencer MP, Caplan LR, Feldmann E, et al. (2004). Assessment: Transcranial Doppler Ultrasonography. Neurology. 62: 1468-81.• Soriano G, Gállego J, Irigoyen ME, Aymerich N (2000). Neurosonología e Ictus. Anales Sis San Navarra. 23(Supl):67-77.• Spencer MP (1997). Transcranial Doppler monitoring and the causes of stroke from carotid endarterectomy. Stroke. 28: 685-91.• Stork JL, Kimura K, Levi CR, Chambers BR, Abbott AL, Donnan GA, et al.(2002). Source of Microembolic signals in patients with high grade carotid stenosis. Stroke. 33: 2014-18.• Valdueza JM, Schreiber SJ, Roehl JE, Klingebiel R (eds) (2008). Neurosonology and neuroimaging of Stroke. Stuttgart. New York: Thieme Publishing Group.• Vernieri F, Pasqualetti P, Passarelli F, Rossini PM, Silvestrini M.(1999) Outcome of carotid artery occlusion is predicted by cerebrovascular reactivity. Stroke. 30: 593-98.• Wijdicks EFM, Varelas PN, Gronseth GS, Greer D (2010). Evidence-based guideline update: Determining brain death in adults. Neurology. 74: 1911-18.• Wilterdink JL, Feldmann E, Furie KL, Bragoni M, Benavides JG (1997). Transcranial Doppler ultrasound battery reliably identifies severe internal carotid artery stenosis. Stroke. 28: 133-36.