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(Stroke. 2009;40:3238.)
© 2009 American Heart Association, Inc.

Original Contributions

Consensus Recommendations for Transcranial Color-Coded Duplex Sonography for the Assessment of Intracranial Arteries in Clinical Trials on Acute Stroke

Max Nedelmann, MD; Erwin Stolz, MD; Tibo Gerriets, MD; Ralf W. Baumgartner, MD; Giovanni Malferrari, MD; Guenter Seidel, MD; Manfred Kaps, MD for the TCCS Consensus Group^*

From Department of Neurology (M.N., E.S., T.G., M.K.), Justus Liebig University, Giessen, Germany; Department of Neurology (R.W.B.), University Hospital of Zurich, Zurich, Switzerland; Department of Neurology (G.M.), Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Department of Neurology (G.S.), University Hospital Schleswig-Holstein, Campus Luebeck, Germany.

Correspondence to Max Nedelmann, MD, Department of Neurology, Justus Liebig University Giessen, Am Steg 14, 35385 Giessen, Germany. E-mail max.nedelmann{at}neuro.med.uni-giessen.de

Background and Purpose— Transcranial color-coded duplex sonography has become a standard diagnostic technique to assess the intracranial arterial status in acute stroke. It is increasingly used for the evaluation of prognosis and the success of revascularization in multicenter trials. The aim of this international consensus procedure was to develop recommendations on the methodology and documentation to be used for assessment of intracranial occlusion and for monitoring of recanalization.

Methods— Thirty-five experts participated in the consensus process. The presented recommendations were approved during a meeting of the consensus group in October 2008 in Giessen, Germany. The project was an initiative of the German Competence Network Stroke and performed under the auspices of the Neurosonology Research Group of the World Federation of Neurology.

Results— Recommendations are given on how examinations should be performed in the time-limited situation of acute stroke, including criteria to assess the quality of the acoustic bone window, the use of echo contrast agents, and the evaluation of intracranial vessel status. The important issues of the examiners’ training and experience, the documentation, and analysis of study results are addressed. One central aspect was the development of standardized criteria for diagnosis of arterial occlusion. A transcranial color-coded duplex sonography recanalization score based on objective hemodynamic criteria is introduced (consensus on grading intracranial flow obstruction [COGIF] score).

Conclusions— This work presents consensus statements in an attempt to standardize the application of transcranial color-coded duplex sonography in the setting of acute stroke research, aiming to improve the reliability and reproducibility of the results of future stroke studies.

Key Words: consensus • stroke transcranial color-coded duplex sonography • ultrasound