Transcranial Doppler Ultrasound in the Current Era of Carotid Artery Stenting

Abstract

Since its introduction in 1982, transcranial Doppler ultrasound (TCD) has become an important diagnostic and monitoring tool and its usefulness has been well established in many clinical applications. In carotid artery stenting (CAS), TCD has mostly been reserved for the optimization of emboli protection devices. Currently, with increasing use of proximal protection systems resembling surgical clamps, TCD has become invaluable in providing the operator an insight into a patient's cerebral hemodynamic status. Additionally, in selected patients, adverse peri- or post-procedural cerebral outcomes may even be predicted allowing the operator to adjust the therapeutic strategy. This review summarizes the current knowledge regarding the use of TCD in patients undergoing CAS and suggests potential directions of future research.

Zusammenfassung

Seit ihrer Einführung im Jahre 1982 entwickelte sich die transkranielle Dopplersonografie (TCD) sich zu einer wichtigen Methode bei der Diagnostik und Überwachung und ihr Wert konnte in vielen klinischen Anwendungen nachgewiesen werden. Beim Karotis-Stenting (CAS) wurde die TCD vor zur Optimierung der Hilfsmittel zum Embolieschutz eingesetzt. Heute ist die TCD durch die verstärkte Anwendung von proximalen Schutzsystemen, die chirurgischen Klemmen (Präparierklemmen) ähneln, unverzichtbar geworden, um den Anwender Einblick in den zerebralen hämodynamischen Status des Patienten zu geben. Darüber hinaus kann sogar bei ausgewählten Patienten eine Vorhersage für zerebrale Folgen während und nach dem Eingriff gemacht werden, wodurch der Anwender die therapeutische Strategie korrigieren kann. Die vorliegende Übersichtsarbeit fasst den aktuellen Wissensstand in Bezug auf den Einsatz der TCD bei Patienten mit CAS zusammen und empfiehlt mögliche Wege für zukünftige Forschungen.

Key words

carotid arteries - ultrasound Doppler - angioplasty

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