Dataset Information

Carotid Artery Ultrasound in the (peri-) Arrest Setting-A Prospective Pilot Study.

ABSTRACT: Point-of-care ultrasounds (US) are used during cardiopulmonary resuscitation (CPR) and after return of spontaneous circulation (ROSC). Carotid ultrasounds are a potential non-invasive monitoring tool for chest compressions, but their general value and feasibility during CPR are not fully determined. In this prospective observational study, we performed carotid US during conventional- and extracorporeal CPR and after ROSC with at least one transverse and coronal image, corresponding loops with and without color doppler, and pulsed-wave doppler loops. The feasibility of carotid US during (peri-)arrest and type and frequency of diagnostic findings were examined. We recruited 16 patients and recorded utilizable US images in 14 cases (88%; complete imaging protocols in 11 patients [69%]). In three of all patients (19%) and in 60% (3/5) of cases during CPR plus a full imaging protocol, we observed: (i) in one patient a collapse of the common carotid artery linked to hypovolemia, and (ii) in two patients a biphasic flow during CPR linked to prolonged low-flow time prior to admission and adverse outcome. Carotid artery morphology and carotid blood flow characteristics may serve as therapeutic target and prognostic parameters. However, future studies with larger sample sizes are needed.

SUBMITTER: Koch M

PROVIDER: S-EPMC8780199 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Carotid Artery Ultrasound in the (peri-) Arrest Setting-A Prospective Pilot Study.

Koch Moritz M Mueller Matthias M Warenits Alexandra-Maria AM Holzer Michael M Spiel Alexander A Schnaubelt Sebastian S

Journal of clinical medicine 20220117 2

Point-of-care ultrasounds (US) are used during cardiopulmonary resuscitation (CPR) and after return of spontaneous circulation (ROSC). Carotid ultrasounds are a potential non-invasive monitoring tool for chest compressions, but their general value and feasibility during CPR are not fully determined. In this prospective observational study, we performed carotid US during conventional- and extracorporeal CPR and after ROSC with at least one transverse and coronal image, corresponding loops with an ...[more]

PMID: 35054163

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Project description:PurposeDifferent non-invasive and invasive imaging modalities are used to determine carotid artery stenosis severity that remains a principal parameter in clinical decision-making. We compared stenosis degree obtained with different modalities against vascular imaging gold standard, intravascular ultrasound, IVUS.Methods300 consecutive patients (age 47-83 years, 192 men, 64% asymptomatic) with carotid artery stenosis of " ≥ 50%" referred for potential revascularization received as per study protocol (i) duplex ultrasound (DUS), (ii) computed tomography angiography (CTA), (iii) intraarterial quantitative angiography (iQA) and (iv) and (iv) IVUS. Correlation of measurements with IVUS (r), proportion of those concordant (within 10%) and proportion of under/overestimated were calculated along with recipient-operating-characteristics (ROC).ResultsFor IVUS area stenosis (AS) and IVUS minimal lumen area (MLA), there was only a moderate correlation with DUS velocities (peak-systolic, PSV; end-diastolic, EDV; r values of 0.42-0.51, p < 0.001 for all). CTA systematically underestimated both reference area and MLA (80.4% and 92.3% cases) but CTA error was lesser for AS (proportion concordant-57.4%; CTA under/overestimation-12.5%/30.1%). iQA diameter stenosis (DS) was found concordant with IVUS in 41.1% measurements (iQA under/overestimation 7.9%/51.0%). By univariate model, PSV (ROC area-under-the-curve, AUC, 0.77, cutoff 2.6 m/s), EDV (AUC 0.72, cutoff 0.71 m/s) and CTA-DS (AUC 0.83, cutoff 59.6%) were predictors of ≥ 50% DS by IVUS (p < 0.001 for all). Best predictor, however, of ≥ 50% DS by IVUS was stenosis severity evaluation by automated contrast column density measurement on iQA (AUC 0.87, cutoff 68%, p < 0.001). Regarding non-invasive techniques, CTA was the only independent diagnostic modality against IVUS on multivariate model (p = 0.008).ConclusionIVUS validation shows significant imaging modality-dependent variations in carotid stenosis severity determination.

Project description:INTRODUCTION:Patients with severe, symptomatic carotid stenosis can have their subsequent stroke risk reduced by surgical intervention if performed soon after a transient ischemic attack (TIA) or stroke. Patients presenting to an emergency department (ED) without computed tomography angiography (CTA) with TIA/stroke, may require transfer to another hospital for imaging to rule out carotid artery stenosis. The objective of this study was to determine the test characteristics of carotid artery point-of-care ultrasound (POCUS) in detecting greater than 50% stenosis in patients presenting with TIA/stroke. METHODS:We conducted a prospective cohort study on a convenience sample of adult patients presenting to a comprehensive stroke centre with TIA or stroke between June-October 2017. Carotid POCUS was performed. Primary outcome measure, stenosis ≥ 50%, was determined by the final radiology report of CTA. A blinded POCUS expert separately reviewed the archived carotid POCUS scans. We calculated sensitivity and specificity for stenosis ≥ 50%. RESULTS:We conducted POCUS on 75 patients, of which 70 were included in our analyses. Of those 70, 14.3% were diagnosed with greater than 50% stenosis. Carotid POCUS performed as follows: sensitivity 70.0% (95% confidence interval [CI], 34.8%-93.3%); specificity 86.7% (95% CI, 75.4%-94.1%); positive likelihood ratio (LR +) 5.3 (95% CI, 1.2-9.3); negative likelihood ratio (LR-) 0.4 (95% CI, 0.0-0.7). The inter-rater reliability between POCUS performer interpretation and expert interpretation had moderate agreement (k = 0.68). Scans took a mean 6.2 ± 2.2 minutes to complete. CONCLUSION:Carotid POCUS has low to moderate association with CTA for detection of carotid artery stenosis ≥ 50%. Further research and investigation is needed prior to widespread use of carotid POCUS in patients with acute cerebral ischemia. Additionally, external validity is likely affected by availability of training, maintenance of competency, and experience in more rural centres.

Project description:Background and purposeCarotid artery stenting (CAS) is emerging as an alternative to carotid endarterectomy for the treatment of carotid artery stenosis (CS), but the effect of CAS on the cognitive function of patients with severe CS has not been fully investigated. The aim of this study was to use comprehensive neuropsychological tests to determine the effect of CAS on cognitive function from baseline to 3 months postprocedure in patients with severe CS.MethodsThirty-one patients due to undergo CAS due to high-grade CS (≥70%) and 11 control subjects who were diagnosed with CS, but who did not undergo CAS, and who visited the clinic or emergency room between February 2009 and February 2012 were recruited consecutively at baseline (i.e., pre-CAS). Follow-up neuropsychological evaluations after 3 months were completed by 23 of the 31 patients who underwent CAS, and by 10 of the 11 control subjects. The primary cognitive outcome was assessed using a neuropsychological test containing subcategories designed to test general cognitive function, attention, visuospatial function, language and related functions, memory, and frontal lobe/executive function.ResultsOf the 23 patients undergoing CAS who completed the 3-month follow-up tests, 12 had asymptomatic CS. During the 3-month follow-up period, the patients who underwent CAS and those with asymptomatic CS achieved similar results to the control group on all cognitive tests. However, symptomatic CS patients (n=11) who underwent CAS exhibited improvements in visuospatial function (p=0.046) and total Seoul Neuropsychological Screening Battery-Dementia Version scores (p=0.010) in comparison with both the asymptomatic CS patients and the control group.ConclusionsThe findings of this study suggest that CAS has a positive effect on cognitive function in patients with symptomatic CS over a 3-month follow-up period. A long-term, multicenter, prospective case-control study would be helpful to predict quality of life and prognoses for patients undergoing CAS.

Project description:BackgroundCarotid ultrasound is a helpful approach for classifying cardiovascular risk. Quantitative flow ratio (QFR) is used to evaluate functionally significant coronary artery stenosis (CAS). The aim of this prospective study was to investigate the correlation between carotid artery features from carotid ultrasound and functionally significant CAS. Furthermore, this study aimed to evaluate the diagnostic performance of carotid ultrasound in diagnosing functional CAS.MethodsCarotid ultrasound was performed in 82 patients with suspicious coronary artery disease, measuring carotid intima-media thickness (IMT), internal artery diameter (IAD), and carotid plaques. QFR values were measured in all patients, and functionally significant CAS was defined as QFR ≤0.8. Forty patients (48.8%) had non-functionally significant CAS with QFR >0.8, while 42 patients (51.2%) had functionally significant CAS with QFR ≤0.8. Logistic regression analyses were performed to evaluate the association among functionally significant CAS, carotid ultrasound features and clinical parameters. A receiver operating characteristic (ROC) curve was developed to assess the capability of carotid ultrasound to diagnose functionally significant CAS.ResultsPatients with functionally significant CAS (QFR ≤0.8) had greater IMT, carotid bifurcation IAD and internal carotid artery-IAD, compared to patients with non-functionally significant CAS, with P values of <0.001, 0.015, and 0.011, respectively. The presence of carotid plaque was significantly higher in the functionally significant CAS group (95.2%) compared to the non-functionally significant CAS group (60%), with a P value of <0.001. In multivariable logistic regression analysis, maximum plaque height (MPH) (OR: 1.777, P=0.018) was associated with functionally significant CAS in patients with coronary artery disease. ROC curves showed plaque area to be superior to IMT, MPH and plaque length in identifying functionally significant CAS. The cutoff value of the plaque area was 9.07, and the sensitivity and specificity were 85.7% and 70.0%.ConclusionsCarotid artery properties measured by carotid ultrasound were associated with functionally significant CAS. Plaque area is the most clinically useful parameter for detecting functionally significant CAS compared to IMT, MPH, and plaque length.

Dataset Information

Carotid Artery Ultrasound in the (peri-) Arrest Setting-A Prospective Pilot Study.

Publications

Carotid Artery Ultrasound in the (peri-) Arrest Setting-A Prospective Pilot Study.

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