shu-508 and Carotid-Artery-Diseases

The use of low frequency probes allows to overcome the resistance of the skull and evaluate Willis's circle by B-mode and Trans-Cranial Color-Doppler (TCCD) to obtain morphological and functional information related to brain circulation during pathologic conditions. With the new software available today modern technology allow us to measure the transient scattering produced by the rupture of the contrast medium microbubbles and estimate the presence of the contrast medium both in macro- and microcircle. In this way it is possible to appraise parenchymal perfusion. This study aims to assess the intracranial micro- and macrocircle using TCCD with contrast medium (Levovist) and to compare the results with the patients' clinical signs.. We studied 21 subjects aged 45-73 years (mean 68 years) with atheromatous uncomplicated plaques in the internal carotid artery producing varying degrees of stenosis and 10 healthy controls. The examinations were performed using an ATL HDI 3000 ultrasound machine with a Phased Array 3.25 MHz probe. The mechanic index was calibrated to high values to obtain rupture of the microbubbles under insonation. Intensity/time curves of transient scattering were extrapolated for both the cerebral macrocircle and the parenchymal microcircle in the region of interest.. The curves were compared with the clinical presentation of the different classes of patients and the results obtained were consistent in showing a clinical pattern of perfusional deficit in subjects with symptoms of chronic brain ischemia. In particular, it was possible to compare the morphologic data relative to the contrast medium decay curves with the patient's clinical condition, confirming the suspicion of cerebral microcircle pathology.. Thanks to improvements in the software and to the definition of effective algorithms, contrast-enhanced TCCD will be able to provide information on brain perfusion in a simple, inexpensive and relatively non-invasive manner.

Topics: Adult; Aged; Algorithms; Brain Ischemia; Carotid Artery Diseases; Carotid Artery, Internal; Carotid Stenosis; Cerebrovascular Circulation; Chronic Disease; Contrast Media; Humans; Intracranial Arteriosclerosis; Middle Aged; Polysaccharides; Software; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Transcranial

The purpose of this study was to evaluate the use of an echo-enhancing agent in patients with carotid artery occlusion to improve the sensitivity and specificity of carotid color flow ultrasonography.. Between January 1997 and December 1998, a prospective study involving 85 cases of carotid artery occlusion in 84 patients was carried out. After a baseline duplex ultrasonography (DU) diagnosis, a second (DU) along with an echo-enhancement agent (SHU-508-A [Levovist]) study was carried out (echo enhancement ultrasonography diagnosis [DUEE]). In 82 cases, a contrast angiography was performed to confirm the diagnosis, whereas in the other three cases the diagnoses were confirmed with surgery.. From the 85 internal carotid artery occlusions diagnosed at the initial DU examination, seven came out to be false occlusions in the DUEE examination (8,2%). There was a 100% correlation of the cases between the DUEE examination and the contrast angiography in the 82 cases in which this had been done. In three of the cases, the diagnosis was confirmed surgically because these displayed severe stenoses according to the DUEE studies in symptomatic patients, and so they required urgent treatment.. The DUEE study is a potent diagnosis tool that allows the differentiation between true carotid artery occlusions and pseudo-occlusions.

Topics: Aged; Angiography; Arterial Occlusive Diseases; Carotid Artery Diseases; Carotid Artery, Internal; Carotid Stenosis; Confidence Intervals; Contrast Media; Evaluation Studies as Topic; False Positive Reactions; Female; Humans; Image Enhancement; Male; Polysaccharides; Predictive Value of Tests; Prospective Studies; Radiographic Image Enhancement; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex

A case of a successful systemic thrombolysis of an acute middle carotid artery occlusion is reported. The case underlines the role of contrast-enhanced transcranial color-coded duplex sonography as a noninvasive technique for rapid diagnosis of vessel occlusion in acute stroke. The diagnostic potential of transcranial color-coded duplex sonography for indication and monitoring of intravenous systemic thrombolytic therapy is demonstrated.

Topics: Acute Disease; Brain Ischemia; Carotid Artery Diseases; Cerebral Arteries; Cerebrovascular Circulation; Cerebrovascular Disorders; Contrast Media; Fibrinolytic Agents; Follow-Up Studies; Humans; Image Enhancement; Male; Middle Aged; Polysaccharides; Thrombolytic Therapy; Thrombosis; Tissue Plasminogen Activator; Ultrasonography, Doppler, Duplex; Ultrasonography, Doppler, Transcranial