Transthoracic echocardiography (TTE) is the current standard of care for the detection of right-to-left shunts (RLS), a known risk factor for ischemic stroke. While this diagnosis is widely available and easy to perform, it has a low sensitivity (about 45%) for the most common type of RLSIt is called the patent foramen ovale (PFO). New data shows that it does not detect the presence of PFO in many cases, which can lead to patients with restless leg syndrome who do not receive the best medical management being misdiagnosed.
It was first described in Journal of Neurosurgery In 1982, transcranial Doppler ultrasound (TCD) was used worldwide as a safe, non-invasive method of screening for restless leg syndrome (RLS), and has sensitivity for PFO approximately 96%, and provides non-invasive, real-time measurements of cerebral hemodynamics.
While TCD can be a valuable tool for monitoring cerebral circulation, it is rarely used because of the specialized knowledge and lengthy training requirements needed to perform the test. A trained healthcare professional must skillfully find the transient window of time, locate the appropriate vessel based on position, angle, and depth, and then expertly interpret the signal. Thus, TCD expertise remains scarce and use limited.
With the incorporation of modern technology that enhances artificial intelligence (AI) and robotics, tcd entered the twenty-first century. It can now be leveraged as an advanced diagnostic tool that healthcare professionals can use without rigorous training.
TCD improves RLS identification
Clinical trial data Presented at the American Heart Association’s 2022 International Stroke Conference evaluating the use of robotics — and AI-assisted TCD — specifically the NovaGuide Intelligent Ultrasound — compared with TTE for the diagnosis of RLS. Polycentric, prospective, single-armed Clinical trial of BUBL Registered adults with neurological signs and symptoms suggestive of an embolic stroke or transient ischemic attack. The robotics component with five degrees of freedom allows each ultrasound probe to independently and independently scan the temporal region to find and improve bilateral cerebral vascular signals. The primary outcome was the shunt detection rate as a percentage of the TTE standard of care.
Study results showed that robotic-assisted TCD was three times more likely to detect RLS in patients with presumed embolic strokes than TTE. Among the 129 evaluable participants, the detection rate for RLS was 64% with NovaGuide and 21% by TTE, a difference of 43%. In addition, NovaGuide identified significant RLS in 27% of participants (Spencer Logarithmic Scale ≥3), while TTE identified significant RLS in only 10% of these cases, a difference of 17%. There were no serious adverse events in this trial.
Notably, the robotic TCD used in the clinical trial was operated by healthcare providers without TCD expertise. The data shows that robotic TCD democratizes the technology, allowing more providers to help patients take advantage of TCD’s sensitivity to detect RLS.
As healthcare evolves, we as healthcare professionals cannot hesitate to take advantage of new technology backed by solid clinical evidence. By integrating robot-assisted TCD into the “brain attack workup”, particularly in centers where TCD expertise is otherwise unavailable, we can make significant improvements toward a more accurate diagnosis of the underlying cause of stroke and thus better preventative treatments.
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