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FAST vessels

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FAST vessels Powered By Docstoc
					FAST



 FAST
       HT300-Series Features

 Received Signal
 Mean Flow
 Waveform Printer
 FlowSound          Computes Trans-Time
                     Volume Flow Measurements
                     in mL/min




                                                2
  Charbel Mircro-Flowprobes



 Designed for Intra-Cranial Use
 Available in 1.5, 2, and 3mm sizes
 Bayonet Handle for use under the microscope
 Malleable probe tip

                                                3
        Short Handle Charbel
            Flowprobes



 Designed for Extra-Cranial Use
 Available in 3, 4, and 6 mm
 Bayonet handle for use under the microscope
 Malleable tip


                                                4
         Theory of Operation




 Ultrasound transducers send and receive signals which
  are altered by blood flow.



                                                          5
6
   Charbel Micro-Flowprobes

 Provide real-time quantitative Flows in cerebral
  vessels, intra-operatively.

 Quick, and easy to use.




                                                     7
Comparing TTU to Doppler




                           8
    Comparing TTU to Doppler
Doppler                   TTU

Red Blood Cell Velocity   Volume Flow Measurements

Flow or no Flow           How much Blood Flow is there?

                          Quantitative Comparisons

                          Helps you to Clearly Understand the
                          Hemodynamic Situation




                                                                9
                       FAST
                 Quantitative Confirmation


 Flow is preserved during aneurysm clippings
 Flow is replaced during aneurysm trappings
 Flow is augmented to ischemic areas




                                                10
          Aneurysm Clippings
 Preserve Blood Flow in Parent and Distal Vessels
 Prevent Stroke

    Intra-operative flow measurements have been shown to
    indicate clipping adjustments in up to 30% of aneurysm cases




                                                                   11
Aneurysm Exposure

           Identify Vessels at risk
           Dissect fat and tissue
            from vessels in
            preparation for Flow
            measurements.




                                   12
              Flowprobe Fit

Vessel should fill 60-
95% of the probe
lumen




                              13
Place Flowprobe

        Flood area with normal
        Saline to establish acoustic
        signal




                                  14
       Taking Measurements

 Check Signal
 Print Waveform
 Record Mean Flow




                             15
16
17
Clip, Re-Measure, and
Compare to Baseline




                        18
19
                 Reduction?
 Generally, a 25% reduction is a cause for concern




                                                      20
Adjust and Measure as
        Needed




                        21
SCA Aneurysm Case
               Baseline 18
               mL/min




               Post-Clip
               4 mL/min




               Adjustment
               18 mL/min


                             22
               EC-IC Bypass

Replacement:               Augmentation

Bypass replaces Flow the   Bypass Increases Flow to
deficit created by an      vessels with naturally
aneurysm trapping, or      occurring occlusive
vessel sacrifice           cerebrovascular disease




                                                23
Cut Flow Measurement




                       24
Evaluating Adequacy




   Courtesy of FT Charbel, MD, FACS
                                      25
  Flow Replacement Protocol
1. Calculate Flow Deficit created by vessel occlusion /
   trapping

2. Match supply to demand by Checking the Cut Flow of
   donor artery

3. Immediately evaluate patency and success of bypass




                                                          26
     Giant Cavernous Carotid
              Case
Vessel                        Flow (mL/min)
M1 Baseline                   70
M1 with clipping ICA          50
Flow Deficit Created          20
STA Cut Flow                  44
Bypass without clipping ICA   4
Bypass with clipping ICA      24



                                              27
             Augmentation

ECA-PCA Bypass

Bypass for ischemia in
posterior circulation




                            28
        Cut Flow Index

                   Completed Bypass Flow
Cut Flow Index =
                   Cut Flow of donor artery




                                              29
30
                       Predictability
A Cut Flow Index > 0.5 has been shown as a sensitive predictor of
bypass function. In 51 bypass cases:


 92% patency rate when CFI > 0.5
 50% patency rate when CFI < 0.



The Cut Flow Index: An Intra-Operative Predictor of the Success of EC-IC
Bypass for Occlusive Cerebrovascular Disease. Amin-Hanjani, S, Du, X.,
Milnarevich, N., Meglio G., Zhao, M., Charbel, FT, Neurosurgery. 2005
56(1) Suppl: 75-85

                                                                           31
             FAST Summary
                 Quantitative Confirmation


 Flow is preserved during aneurysm clippings
 Flow is replaced during aneurysm trappings
 Flow is augmented to ischemic areas




                                                32
                                  FAST Leaders
USA                                                           Netherlands
University of Illinois at Chicago, Chicago, IL                University Utrecht, Utrecht, Netherlands
Charbel, Fady T., MD, Chair, Neuropsychiatric Institute (MC
799), Department of Neurosurgery
                                                              Van der Zwan, Bart, MD, Professor, Department of
                                                              Neurosurgery, Streefkerk, H.J.Tulleken, C.A. (retired
Stanford University School of Medicine, Palo Alto, CA         2005)
Steinberg, Gary K., MD, Chair, Department of Neurosurgery     University Maastricht, Maastricht, Netherlands
                                                              Dings, Jim MD, Department of Neurosurgery,
Harvard University, Cambridge, MA
Olgilvy, Christopher S., MD, Professor of Neurosurgery,
                                                              Spincemaille, Geert, MD, Department of Neurosurgery,
Attending neurosurgeon, Mass General Hospital
                                                              Italy
Mayo Clinic, Rochester, MN                                    University Verona, Verona, Italy
Meyer, Fred B. MD, Chair, Department of Neurosurgery          Pasqualin, A., MD, Department of Neurosurgery
St. Luke's-Roosevelt Hospital Center and Albert Einstein
                                                              University Padova, Padova, ItalyScienza, R, Prof,
College of Medicine, NY Langer, David J., MD, Department      Department of Neurosurgery Pavesi, Giacomo, MD,
of Neurosurgery/INN                                           Department of Neurosurgery

University of Miami, Miami, FLMarcos, Jacque, MD,             Japan
Associate Professor
                                                              Hokkaido University School of Medicine, Sapporo ,
Germany                                                       Japan
                                                              Nakayama, N., MD Department of Neurosurgery
University of Mannheim, Mannheim, Germany
Vajkoczy, Peter, MD, Department of Neurosurgery               Taiwan
                                                              Tu, MD National Taiwan University   Lin - Veterins
                                                              General Hospital – Taipei

                                                              Australia
                                                              Khuranna, MD, Canberra


                                                                                                                   33
www.transonicasia.com/neuro


                              34
                 Extra-Corporeal
                                                    Tissue
Cardiovascular                         Research     Perfusion




Neuro            Dialysis          Angioplasty    VAD / OEM

                                                           35
                Proven
Independently validated in many applications
and referenced in over 4,000 publications in
the past 25 years.




                                               36
Thank You




            37

				
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posted:8/8/2011
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