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• W2103403971 abstract "We thank Sharma et al. for their comments on our paper which shows that measuring microembolic signals with transcranial Doppler at the level of the basilar artery across the foramen magnum (transforaminal approach) is an alternative for the detection of right-to-left cardiac shunt (RLS) in the absence of temporal bone windows [ [1] Perren F. Savva E. Landis T. Transforaminal Doppler: an alternative to transtemporal approach for right-to-left cardiac shunt assessment. J Neurol Sci. 2008; 273: 49-50 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar ]. We entirely agree with their comments that other extratemporal approaches such as using the vertebral arteries [ [2] Del Sette M. Dinia L. Rizzi D. Sugo A. Albano B. Gandolfo C. Diagnosis of right-to-left shunt with transcranial Doppler and vertebrobasilar recording. Stroke. 2007; 38: 2254-2256 Crossref PubMed Scopus (42) Google Scholar ], the common carotid arteries or even more peripheral arteries such as the contralateral brachial or femoral arteries [ [3] Daly K.J. Hutchinson S. McCollum C.N. Can a peripheral artery be used to detect venous-to-arterial circulation shunts?. Cerebrovasc Dis. 2007; 25: 111-114 Crossref PubMed Scopus (10) Google Scholar ] are alternatives for the detection of RLS. Moreover, it appears that a number of methodological factors, such as the use of power M-mode transcranial Doppler with its multiple gates [ [4] Spencer M.P. Moehring M.A. Jesurum J. Gray W.A. Olsen J.V. Reisman M. Power M-mode transcranial Doppler for diagnosis of patent foramen ovale and assessing transcatheter closure. J Neuroimaging. 2004; 14: 342-349 Crossref PubMed Scopus (130) Google Scholar ], measuring MES in a sitting position [ [5] Lao A.Y. Sharma V.K. Tsivgoulis G. Malkoff M.D. Alexandrov AV Frey J.L. Effect of body positioning during transcranial Doppler detection of right-to-left shunts. Eur J Neurol. 2007; 14: 1035-1039 Crossref PubMed Scopus (46) Google Scholar ], the addition of blood and increased agitation of the mixture [ [6] Sastry S. Daly K. Chengodu T. McCollum C. Is transcranial Doppler for the detection of venous-to-arterial circulation shunts reproducible?. Cerebrovasc Dis. 2007; 23: 424-429 Crossref PubMed Scopus (40) Google Scholar ], or the use of galactose based contrast agent during Valsalva's maneuver [ [7] Uzuner N. Horner S. Pichler G. Svetina D. Niederkorn K. Right-to-left shunt assessed by contrast transcranial Doppler sonography: new insights. J Ultrasound Med. 2004; 23: 1475-1482 PubMed Google Scholar ], may all enhance sensitivity of the detection of RLS. All these methods achieve a detection of RLS with slightly different degrees of excellence and a good correlation with transesophageal echocardiography. However, as Sharma et al. point out, there exists actually no widely accepted protocol for the “best” procedure." @default.
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• W2103403971 date "2009-04-01" @default.
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• W2103403971 title "Commentary to: “Alternatives to transtemporal approach of transcranial Doppler for the detection of right-to-left cardiac shunt” by V. Sharma et al." @default.
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• W2103403971 doi "https://doi.org/10.1016/j.jns.2009.01.002" @default.
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