on December 8, 2005
Published online before print December 8, 2005, doi: 10.1161/01.STR.0000196988.45318.97
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on May 13, 2005
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. * To whom correspondence should be addressed. 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.
Revised on October 19, 2005
Accepted on October 31, 2005
Telemedicine-Guided Carotid and Transcranial Ultrasound. A Pilot Feasibility Study
Robert Mikulik MD;
Key words: Doppler, transcranial • stroke • telemedicine • ultrasonography