Abstract
Contrast-enhanced transcranial Doppler (c-TCD) is a reliable and reproducible method for right-to-left shunt (RLS) detection, with high sensitivity. Monitoring the middle cerebral artery (MCA) is an optimal choice, yet for patients with insufficient temporal bone windows or severe stenosis of carotid arteries, an alternative should be established. The aim of the present study was to further establish whether c-TCD with vertebral artery (VA) monitoring is as effective as MCA monitoring for RLS detection. We evaluated 194 subjects for RLS detection with VA and MCA monitoring simultaneously. There was no significant difference between the positive rates of VA and MCA monitoring for RLS detection. c-TCD with VA monitoring could be an alternative for RLS detection, with high sensitivity and specificity both at rest and during the Valsalva manoeuvre.
Highlights
Right-to-left shunt (RLS) has been recently reported in a number of clinical conditions, such as migraine, platypnea-orthodeoxia, obstructive apnea, and decompression sickness[1]
Different results might be detected in the same patient, there was no significant difference between left middle cerebral artery (LMCA) and left vertebral artery (LVA) monitoring for right-to-left shunt (RLS) detection, including constant and provoked RLS
The sensitivity and specificity of LVA monitoring were relatively high, with the LMCA taken as the standard (Tables 2–4)
Summary
Right-to-left shunt (RLS) has been recently reported in a number of clinical conditions, such as migraine, platypnea-orthodeoxia, obstructive apnea, and decompression sickness[1]. The presence of RLS is a well-known risk factor for cryptogenic stroke[2]. Related ischemic lesions are located predominantly in the vertebrobasilar circulation (VBC), especially in patients with provoked RLS3. Contrast-enhanced transcranial Doppler (c-TCD) has been widely used in detecting both cardiac and extracardiac RLS, as it is more reliable and reproducible with higher sensitivity compared with invasive transesophageal echocardiography (TEE)[4,5]. RLS detection is limited by insufficient temporal bone windows in 10–20% of stroke patients[6]. C-TCD with vertebrobasilar monitoring has been considered and compared for detecting RLS9,10. The aim of our study was to further establish whether c-TCD with vertebral artery (VA) monitoring is as effective as middle cerebral artery (MCA) monitoring for RLS detection in a Chinese population
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