EL ULTRASONIDO CON DISPOSITIVOS PORTATILES ES UTIL PARA EL DIAGNOSTICO DEL ICTUS AGUDO





EL ULTRASONIDO CON DISPOSITIVOS PORTATILES ES UTIL PARA EL DIAGNOSTICO DEL ICTUS AGUDO

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La ecografía Doppler transcraneal y el dúplex carotídeo pueden realizarse mediante dispositivos portátiles, lo que permite su utilización junto a la cama del paciente en el Servicio de Urgencias y en la sala de neurointervencionismo.
martinez9_91112.jpg Autor:
Patricia Martínez Sánchez
Columnista Experta de SIIC

Institución:
Hospital Universitario La Paz


Artículos publicados por Patricia Martínez Sánchez
Recepción del artículo
24 de Noviembre, 2011
Aprobación
2 de Agosto, 2012
Primera edición
21 de Septiembre, 2012
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La ecografía Doppler transcraneal (EDTC) y el dúplex carotídeo (DC) pueden realizarse mediante dispositivos portátiles, lo que permite su utilización junto a la cama del paciente en el Servicio de Urgencias y en la sala de neurointervencionismo. Ambas técnicas permiten el diagnóstico del estado del árbol vascular cerebral y facilitan un diagnóstico rápido y una decisión terapéutica adecuada. Existe una creciente utilización del dúplex transcraneal (DuTC), que nos permite, además, la valoración del parénquima cerebral, lo que es especialmente útil en la monitorización de la evolución de las hemorragias cerebrales, el efecto masa intracraneal y la hidrocefalia. Finalmente, la EDTC tiene un efecto terapéutico, ya que potencia la recanalización con activador tisular del plasminógeno (tPA). La EDTC, el DuTC y el DC son herramientas diagnósticas excelentes que deberían utilizarse en la evaluación inmediata de todos los pacientes con ictus isquémico o hemorrágico agudo.

Palabras clave
ultrasonido transcraneal, ultrasonido carotídeo, ecocontrastes, infarto cerebral, hemorragia cerebral


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Abstract
Transcranial Doppler (TCD) and carotid duplex (CD) can be used as portable tests, thus allowing for bedside use in the Emergency Service and Neurointerventional Room. Both tests broaden the abilities of the stroke neurologist to rapidly evaluate the vascular tree, facilitating a rapid diagnosis and appropriate therapeutic decisions. There is a growing use of transcranial duplex (TCDu), which also allows assessment of the brain parenchyma, which is especially useful in monitoring the evolution of brain hemorrhage, intracranial mass effect and hydrocephalus. Finally, the TCD has a therapeutic effect because it enhances arterial recanalization after tPA administration. The TCD, TCDu and CD are excellent diagnostic tools that should be used in all patients with ischemic or hemorrhagic stroke.

Key words
transcranial ultrasound, carotid ultrasound, microbubble contrast agents, brain infarction, cerebral hemorrhage


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cuidados Intensivos, Diagnóstico por Imágenes
Relacionadas: Emergentología, Geriatría, Medicina Interna, Neurocirugía, Neurología, Salud Pública



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Patricia Martínez Sánchez, Hospital Universitario La Paz Centro de Ictus y Servicio de Neurología, Madrid, España
Bibliografía del artículo
1. Song JK, Cacayorin ED, Campbell MS, y col. Intracranial balloon angioplasty of acute terminal internal carotid artery occlusion. AJNR Am J Neuroradiol 23:1308-1312, 2002.
2. Eckstein HH, Schumacher H, Dorfler A, y col. Carotid endarterectomy and intracranial thrombolysis: simultaneous and staged procedures in ischemic stroke. J Vasc Surg 19:459-471, 1999.
3. Wong KS, Li H, Chan YL, Ahuja A, Lam WWM, Wong A, Kay R. Use of transcranial Doppler ultrasound to predict outcome in patients with intracranial large-artery occlusive disease. Stroke 31:2641-2647, 2000.
4. Purroy F, Montaner J, Delgado P, y col. Usefulness of urgent combined carotid/transcranial ultrasound testing in early prognosis of TIA patients. Med Clin (Barc) 126:647-50, 2006.
5. Saqqur M, Molina CA, Salam A, y col. for the CLOTBUST Investigators. Clinical deterioration after intravenous recombinant tissue plasminogen activator treatment: a multicenter transcranial Doppler study. Stroke 38:69-74, 2007.
6. Saqqur M, Uchino K, Demchuk AM, y col. for the CLOTBUST Investigators. Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke 38:948-954, 2007.
7. Alexandrov AV, Molina CA, Grotta JC, y col. for the CLOTBUST Investigators. Ultrasound-enhanced thrombolysis for acute ischemic stroke. N Engl J Med 351:2170-2178, 2004.
8. Santamarina E, Delgado-Medeiros R, Rubiera M, y col. Transcranial duplex sonography for monitoring hyperacute intracrerebral hemorrhage. Stroke 40:987-990, 2009.
9. Bertram M, Khoja W, Ringleb P, Schwab S. Transcranial colour-coded sonography for the bedside evaluation of mass effect after stroke. European Journal of Neurology 7:639-646, 2000.
10. Kiphuth IC, Huttner HB, Struffert T, Schwab S, Köhrmann M. Sonographic monitoring of ventricle enlargement in poshemorrhagic hydrocephalus. Neurology 76:858-862, 2011.
11. Martínez-Sánchez P, Ruiz-Ares G, Díez-Tejedor E. Estudio de la placa ateromatosa carotídea. En: Manual de Neurosonología. Ed. Panamericana, Madrid; 2011. pp. 104-116.
12. Chernyshev OY, Garami Z, Calleja S, y col. Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia. Stroke 36:32-37, 2004.
13. Martínez-Sánchez P, Tsivgoulis G, Lao A, Sharma V, Alexandrov V. Ultrasound in acute ischemic stroke. Neurologia 24(1):59-68, 2009.
14. Martínez Sánchez P, Serena J, Alexandrov AV, Fuentes B, Fernández-Domínguez J, Díez-Tejedor E. Update on ultrasound techniques for the diagnosis of cerebral isquemica. Cerebrovasc Dis 27 Suppl 1:9-18, 2009.
15. Perren F, Loulidi J, Graves R y col. Combined IV-intraarterial thrombolysis: a color-coded duplex pilot study. Neurology 67:324-326, 2006.
16. Demchuk AM, Burgin WS, Christou I, y col. 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, 2001.
17. Burgin WS, Malkoff M, Felberg RA, y col. Transcranial Doppler ultrasound criteria for recanalization after thormbolysis for middle cerebral artery stroke. Stroke 13:1128-1132, 2000.
18. Labiche LA, Malkoff M, Alexandrov AV. Residual flow signals predict complete recanalization in stroke patients treated with TPA. J Neuroimaging 13:28-33, 2003.
19. Rubiera M, Cava L, Tsivgoulis G, y col. Diagnostic criteria and yield or real-time transcranial Doppler monitoring of intra-arterial reperfusion procedures. Stroke 41(4):695-9, 2010.
20. Alexandrov AV, Tsivgoulis G, Rubiera M, y col. for the TUCSON Investigator. End-diastolic velocity increase predicts recanalizzation and neurological improvement inpatients with ischemic stroke with proximal arterial occlusions receiving reperfusion therapies. Stroke 41(5):948-52, 2010.
21. Eggers J, Pade O, Rogge A, Schreiber SJ, Valdueza JM. Transcranial color-coded sonography successfully visualizes all intracranial parts of the internal carotid artery using the combined transtemporal axial and coronal approach. AJNR Am J Neuroradiol 30(8):1589-1593, 2009.
22. Sallustio F, Kern R, Günther M, y col. Assessment of intracranial collateral flow by using dynamic arterial spin labeling MRA and transcranial color-coded duplex ultrasound. Stroke 39: 1894-1897, 2008.
23. Postert T, Braun B, Meves S, y col. Contrast-enhanced transcranial color-coded sonography in acute hemispheric brain infarction. Stroke 30:1819-1826, 1999.
24. Baumgartner RW, Heinrich P, Mattle P, Schroth G. Assessment of = 50% and < 50% intracranial stenoses by transcranial color-coded duplex sonography. Stroke 30:87-92, 1999.
25. Kunz A, Hahn G, Mucha D, y col. Echo-enhanced transcranial color-coded duplex sonography in the diagnosis of cerebovascular events: a validation study. AJNR 27:122-127, 2006.
26. Gerriets T, Postert T, Goertler M, y col. DIAS I: duplex-sonographic assessment of the cerebrovascular status in acute stroke: a useful tool for future stroke trials. Stroke 31:2342-2345, 2000.
27. Gerriets T, Goertler M, Stolz E, y col. Feasibility and validity of transcranial duplex sonography in patients with acute stroke. J Neurol Neurosurg Psychiatry 73:17-20, 2002.
28. Nedelmann M, Stolz E, Gerriets T, y col. for the TCCS consensus group. Consensus recommendations for transcranial color-coded duplex sonography for the assessment of intracranial arteries in clinical trials on acute stroke. Stroke 40:3238-3244, 2009.
29. Molina CA, Ribo M, Rubiera M, y col. Microbubble administration accelerates clot lysis during continuous 2-MHz ultrasound monitoring in stroke patients treated with intravenous tissue plasminogen activator. Stroke 37:425-9, 2000.
30. Molina CA, Barreto AD, Tsivgoulis G, y col. Transcranial ultrasound in clinica sonothrombolysis (TUCSON) trial. Ann Neurol 66(1):28-38, 2009.
31. Eggers J. Acute stroke: therapeutic transcranial color duplex sonography. Front Neurol Neurosci 21:162-70, 2006.
32. Gerriets T, Stolz E, König S, y col. Sonographic monitoring of midline shift in space-occupying stroke: an early outcome predictor. Stroke 32:442-447, 2001.
33. Seidel G, Cangür H, Albers T, Burgemeister A, Meyer-Wiethe K. Sonographic evaluation of hemorrhagic transformation and arterial recanalization in acute hemispheric ischemic stroke. Stroke 40:119-123, 2009.
34. Pérez ES, Delgado-Mederos R, Rubiera M, y col. Transcranial dúplex sonography for monitoring hyperacute intracerebral hemorrage. Stroke 40(3):987-990, 2009.
35. Gronholdt ML, Nordestgaard BG, Wiebe BM, y col. Echo-lucency of computerized ultrasound images of carotid atherosclerotic plaques are associated with increased levels of triglyceride-rich lipoproteins as well as increased plaque lipid content. Circulation 97:34-40, 1998.
36. Mathiesen EB, Bonaa KH, Joakimsen O. Echolucent plaques are associated with high risk of ischemic cerebrovascular events in carotid stenosis: the Tromso Study. Circulation 103:2171-2175, 2001.
37. Ohki T, Marin ML, Lyon RT, y col. Ex vivo human carotid artery bifurcation stenting: correlation of lesion characteristics with embolic potential. J Vasc Surg 27:463-471, 1998.
38. Tegos TJ, Sabetai MM, Nicolaides AN, y col. Correlates of embolic events detected by means of transcranial Doppler in patients with carotid atheroma. J Vasc Surg 33:131-138, 2001.
39. Henry M, Henry I, Klonaris C, y col. Benefits of cerebral protection during carotid stenting with the PercuSurge GuardWire system: midterm results. J Endovasc Ther 9:1-13, 2002.
40. Sztajzel R, Momjian-Mayor I, Comelli M, Momjian S. Correlation of cerebrovascular symptoms and microembolic signals with the stratified gray-scale median analysis and color mapping of the carotid plaque. Stroke 37:824-829, 2006.
41. Ruiz-Ares G, Fuentes B, Martínez-Sánchez P, Martínez-Martínez M, Díez-Tejedor E. Utility of the assessment of echogenicity in identification of symptomatic carotid artery atheroma plaques in ischaemic stroke patients. Cerbrovasc Dis 2011. In press.
42. Martínez-Sánchez P, Fernández-Domínguez J, Ruiz-Ares G, Fuentes B, Alexandrov AV, Díez-Tejedor E. Changes in carotid plaque echogenicity with time since the stroke onset: the UNPACK study. Stroke 41:e479, 2010.

 
 
 
 
 
 
 
 
 
 
 
 
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