Real-time flow monitoring using TCD gives hemodynamic information to clinicians regarding to successful recanalization in in the occluded vessel of acute ischemia, plaque stability by detecting microemboli and collateral reservoir by vasomotor reactivity test. Therefore, TCD monitoring could be used for hemodynamic change in various clinical situations. A routine TCD technique in combination with headframe with dual probe fixation devices provide real-time flow monitoring. TCD examination should contain 1) the transtemporal approach for the middle cerebral, anterior cerebral and posterior cerebral arteries, 2) the transorbital approach for the ophthalmic artery and internal carotid artery siphon 3) the transforaminal approach for both vertebral and basilar arteries. Based on the present reports and expert’s consensuses, a routine TCD evaluation should include velocity measurement and waveform recording of the major intracranial vessels of circle of Willis and the extracranial carotid arteries via three transcranial and one submandibular insonation. However, in addition to the dependency of examiner’s skills and experience, lack of the standardized scanning protocols is one of obstacles to overcome. TCD has strong advantages of easy accessibility in time and space, and non-invasiveness over other imaging techniques. Transcranial Doppler ultrasound (TCD) has been widely used to assess and monitor cerebrovascular hemodynamics. Transcranial Doppler Ultrasound: Practice Standards Part I.
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