Title: FAST
1FAST
Flow-Assisted Surgical Technique In
Cerebrovascular Surgery
2HT300-Series Features
- Received Signal
- Mean Flow
- Waveform Printer
- FlowSound
Computes Trans-Time Volume Flow Measurements in
mL/min
3Charbel 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
4Short Handle Charbel Flowprobes
- Designed for Extra-Cranial Use
- Available in 3, 4, and 6 mm
- Bayonet handle for use under the microscope
- Malleable tip
5Theory of Operation
- Ultrasound transducers send and receive signals
which are altered by blood flow.
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7Charbel Micro-Flowprobes
- Provide real-time quantitative Flows in cerebral
vessels, intra-operatively. - Quick, and easy to use.
8Comparing TTU to Doppler
9Comparing 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
10FAST
Quantitative Confirmation
- Flow is preserved during aneurysm clippings
- Flow is replaced during aneurysm trappings
- Flow is augmented to ischemic areas
11Aneurysm 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
12Aneurysm Exposure
- Identify Vessels at risk
- Dissect fat and tissue from vessels in
preparation for Flow measurements.
13Flowprobe Fit
- Vessel should fill 60-95 of the probe lumen
14Place Flowprobe
Flood area with normal Saline to establish
acoustic signal
15Taking Measurements
- Check Signal
- Print Waveform
- Record Mean Flow
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18Clip, Re-Measure, and Compare to Baseline
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20Reduction?
- Generally, a 25 reduction is a cause for concern
21Adjust and Measure as Needed
22SCA Aneurysm Case
Baseline 18 mL/min
Post-Clip4 mL/min
Adjustment18 mL/min
23EC-IC Bypass
Replacement Bypass replaces Flow the deficit
created by an aneurysm trapping, or vessel
sacrifice
Augmentation Bypass Increases Flow to vessels
with naturally occurring occlusive
cerebrovascular disease
24Cut Flow Measurement
25Evaluating Adequacy
Courtesy of FT Charbel, MD, FACS
26Flow Replacement Protocol
- Calculate Flow Deficit created by vessel
occlusion / trapping - Match supply to demand by Checking the Cut Flow
of donor artery - Immediately evaluate patency and success of bypass
27Giant 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
28Augmentation
ECA-PCA Bypass Bypass for ischemia in posterior
circulation
29Cut Flow Index
Completed Bypass Flow
Cut Flow Index
Cut Flow of donor artery
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31Predictability
A Cut Flow Index gt 0.5 has been shown as a
sensitive predictor of bypass function. In 51
bypass cases
- 92 patency rate when CFI gt 0.5
- 50 patency rate when CFI lt 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
32FAST Summary
Quantitative Confirmation
- Flow is preserved during aneurysm clippings
- Flow is replaced during aneurysm trappings
- Flow is augmented to ischemic areas
33FAST Leaders
USA University of Illinois at Chicago, Chicago,
IL Charbel, Fady T., MD, Chair, Neuropsychiatric
Institute (MC 799), Department of Neurosurgery
Stanford University School of Medicine, Palo
Alto, CA Steinberg, Gary K., MD, Chair,
Department of Neurosurgery Harvard University,
Cambridge, MA Olgilvy, Christopher S., MD,
Professor of Neurosurgery, Attending
neurosurgeon, Mass General Hospital Mayo Clinic,
Rochester, MN Meyer, Fred B. MD, Chair,
Department of Neurosurgery St. Luke's-Roosevelt
Hospital Center and Albert Einstein College of
Medicine, NY Langer, David J., MD, Department
of Neurosurgery/INN University of Miami, Miami,
FLMarcos, Jacque, MD, Associate
Professor Germany University of Mannheim,
Mannheim, Germany Vajkoczy, Peter, MD, Department
of Neurosurgery
Netherlands University Utrecht, Utrecht,
Netherlands Van der Zwan, Bart, MD, Professor,
Department of Neurosurgery, Streefkerk,
H.J.Tulleken, C.A. (retired 2005) University
Maastricht, Maastricht, Netherlands Dings, Jim
MD, Department of Neurosurgery, Spincemaille,
Geert, MD, Department of Neurosurgery,
Italy University Verona, Verona,
Italy Pasqualin, A., MD, Department of
Neurosurgery University Padova, Padova,
ItalyScienza, R, Prof, Department of Neurosurgery
Pavesi, Giacomo, MD, Department of Neurosurgery
Japan Hokkaido University School of Medicine,
Sapporo , Japan Nakayama, N., MD Department of
Neurosurgery Taiwan Tu, MD National Taiwan
University Lin - Veterins General Hospital
Taipei Australia Khuranna, MD, Canberra
34www.transonicasia.com/neuro
35Extra-Corporeal
Tissue Perfusion
Research
Cardiovascular
Neuro
Dialysis
Angioplasty
VAD / OEM
36Proven
Independently validated in many applications and
referenced in over 4,000 publications in the past
25 years.
37Thank You