Key result
Combined PMD/sgTCD criteria improved the detection of microembolic signals compared to sgTCD alone (326 vs 269 total signals; P=0.005) and increased interpretation reliability (ICC 0.91 vs 0.67).
Why the study?
Does combined PMD/sgTCD criteria improve microemboli detection and reliability compared to sgTCD alone in patients with symptomatic carotid disease?
Observational (n=92)
Does combined PMD/sgTCD criteria improve microemboli detection and reliability compared to sgTCD alone in patients with symptomatic carotid disease?
p-value: p=0.005
Combining Power M-mode Doppler with single gate transcranial Doppler significantly improves the detection yield and interpretation reliability of microembolic signals in patients with symptomatic carotid disease.
May enhance microemboli monitoring in symptomatic carotid disease; hypothesis-generating and should not change practice without prospective validation.
BACKGROUND AND PURPOSE: Single gate transcranial Doppler spectrogram (sgTCD) has a high variability in the detection of microembolic signals (MES), Adding Power M-mode Doppler (PMD) information may improve MES detection. Our study's aim is to derive combined PMD/sgTCD microemboli criteria to overcome this limitation. METHODS: Patients with symptomatic carotid disease were prospectively enrolled within 24 h of symptom onset underwent 1 hour TCD emboli monitoring. We reviewed disparity between PMD MES criteria and sgTCD MES criteria. We compared combined PMD/sgTCD criteria to sgTCD alone criteria by measuring the intraclass correlation coefficient (ICC). RESULTS: Of 92 patients, 28 patients had evidence of MES on sgTCD or PMD. Total MES count was 269 based on sgTCD criteria, and 326 based on combined PMD/sgTCD criteria (P= 0.005). Combined PMD/sgTCD criteria revealed 17 MESs (4.8%) based on sgTCD criteria to represent artifacts and 57 MESs (17.5%) not to be detected by sgTCD criteria. Overall ICC based on sgTCD criteria was 0.67 [95% confidence interval (CI): 0.58-0.74]; however, introducing combined PMD/sgTCD criteria resulted in a significant increase in the ICC, 0.91 (95% CI: 0.88-0.93). CONCLUSION: Our combined PMD/sgTCD criteria for MES appeared to improve the yield of MES detection. Reliability in MES detection interpretation was improved when combined PMD/sgTCD criteria was applied.
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Choi et al. (2009) conducted an observational in symptomatic carotid disease (n=92). Combined Power M-mode Doppler and single gate transcranial Doppler (PMD/sgTCD) criteria vs. Single gate transcranial Doppler (sgTCD) alone criteria was evaluated on Total microembolic signals (MES) count (p=0.005). Combined PMD/sgTCD criteria improved the detection of microembolic signals compared to sgTCD alone (326 vs 269 total signals; P=0.005) and increased interpretation reliability (ICC 0.91 vs 0.67).
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