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Shooka Esmaeeli,Courtney M. Hrdlicka,Andres Brenes Bastos,Jeffrey Wang,Santiago Gomez-Paz,Khalid A. Hanafy,Vasileios-Arsenios Lioutas,Christopher S. Ogilvy,Ajith J. Thomas,Shahzad Shaefi,Corey R. Fehn 대한신경집중치료학회 2020 대한신경집중치료학회지 Vol.13 No.1
Background: Transcranial Doppler (TCD) ultrasound is an essential tool for the detection of cerebral vasospasm after subarachnoid hemorrhage (SAH) but is limited by the availability of skilled operators. We examined the clinical feasibility and concordance of a robotically assisted TCD system with artificial intelligence with routine handheld TCD after SAH. Methods: We evaluated TCD velocities in the anterior cerebral artery (ACA) and middle cerebral artery (MCA) of two patients with high-grade SAH and angiographic evidence of vasospasm. A single channel TCD device with a handheld diagnostic probe as well as a robotically assisted TCD device was used, the relationship of the two tests was evaluated using the bootstrap method of resampling for the concordance correlation coefficient (CCC) paired with a Pearson’s correlation analysis, followed by a Bland-Altman plot. Results: Patient 1 developed angiographic and TCD evidence of vasospasm in the proximal right MCA, but except for periods of disorientation remained neurologically intact. Angiographic, TCD and clinical evidence of ACA spasm occurred 6 days after ictus in patient 2. Robotically measured mean flow velocities were comparable to manual TCDs in the MCAs (CCC=0.83; 95% confidence interval [CI], 0.42 to 0.96; P=0.001) but not in the ACAs (CCC=0.26; 95% CI, –0.01 to 0.71; P=0.26). Conclusion: Robotically assisted TCD system with artificial intelligence provides an alternative to manual TCD for assessment of MCA velocities in patients with SAH, expanding the availability of TCD to settings in which specialized clinicians are not available. Further studies for validation of this technology are warranted.
Isa Khaheshi,Mohammad Parsa Mahjoob,Shooka Esmaeeli,Vahid Eslami,Habib Haybar 대한심장학회 2015 Korean Circulation Journal Vol.45 No.2
This case report underscores that crystal methamphetamine abuse is an important cause of multivessel coronary thrombosis and raisesdoubts about the therapeutic options. The patient was a 34-year-old smoker and crystal methamphetamine abuser with no significantmedical history, who presented with retrosternal chest pain associated with cold sweats. Twelve-lead electrocardiogram revealed diffuseST-segment elevation in I, II, AVL, AVF, and V 2–6 leads. He underwent urgent coronary angiography and it showed Thrombolysis in MyocardialInfarction (TIMI) grade 3 flow in coronary arteries and presence of a thrombus in the left anterior descending artery (LAD) and the rightcoronary artery (RCA). The patient underwent medical therapy with antiplatelet agents and anticoagulants. Repeat coronary angiographyafter three months of dual therapy with warfarin and aspirin did not show any thrombus or any significant lesion in the RCA and the LADhaving TIMI grade 3 flow.