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(Stroke. 2006;37:229.)
© 2006 American Heart Association, Inc.

Research Reports

Telemedicine-Guided Carotid and Transcranial Ultrasound

A Pilot Feasibility Study

Robert Mikulik, MD; Andrei V. Alexandrov, MD; Marc Ribo, MD; Zsolt Garami, MD; Nichole A. Porche, RN; Eva Fulep, MD; James C. Grotta, MD; Anne W. Wojner-Alexandrov, PhD, FAAN John Y. Choi, MD, MPH

From the Department of Neurology (R.M., M.R., Z.G., N.A.P., E.F., J.C.G., J.Y.C.), University of Texas Health Science Center at Houston; Barrow Neurological Institute (A.V.A.), Phoenix, Ariz; Arizona State University, School of Nursing (A.W.W.-A.), Tempe, Ariz.

Correspondence to John Y. Choi, MD, MPH, Department of Neurology, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 7.124, Houston, TX 77030. E-mail John.Y.Choi{at}uth.tmc.edu

Background and Purpose— Transcranial Doppler (TCD) and carotid duplex (CD) provide rapid and safe screening for stroke patients but are highly operator dependent. We explored the feasibility of telemedicine (TM)-guided TCD/CD administered by a health care provider inexperienced with ultrasound.

Methods— Dual video screens transmitted real-time TCD/CD images and sound to a neurosonographer. TM TCD/CD characteristics were compared with an in-person (IP) examination independently obtained on the same patient. We compared carotid stenosis, thrombolysis in brain ischemia (TIBI) flow grades, and the time spent on testing.

Results— We examined 8 subjects with a median age of 51 (31 to 63 range). IP and TM successfully examined 100% of internal carotid and middle cerebral arteries, 50% versus 44% of anterior cerebral artery, and 100% versus 88% of the basilar arteries, respectively. The median time in minutes IP versus TM was 15 (range 10 to 35) and 30 (15 to 50) for CD (P=0.07) and 18 (15 to 30) and 45 (30 to 55) for TCD (P=0.002), respectively. TM correctly identified all normal CD/TCD examinations in 7 subjects. In 1 patient, TM identified carotid occlusion but misread TIBI flow grades in both middle cerebral arteries.

Conclusions— Our pilot study showed the feasibility of TCD/CD by an inexperienced health professional guided by a sonographer via TM. Tests were completed within times comparable to outpatient setting in a vascular laboratory.

Key Words: Doppler, transcranial • stroke • telemedicine • ultrasonography