Detection of MCA embolization during transcranial Doppler monitoring

Continuous transcranial Doppler ultrasound (TCD) monitoring of the middle cerebral artery (ACM) is a potent new technique in detecting thromboembolic and haemodynamic complications in interventional neuroradiology. An illustrative case is reported of a 6-year-old boy suffering from right-sided rhabdomyosarcoma of the neck in which permanent balloon occlusion of the right ACI was attempted. During the procedure, repeated severe thromboembolic events with temporary occlusion of the M1 segment of the ACM could be detected by TCD monitoring. Complications could then be avoided by cessation of the undertaking and lysis therapy with urokinase. The report concludes that TCD monitoring during endovascular treatment provides important insight into the thromboembolic pathophysiology, guides management strategies, helps in the avoidance of devastating events and should be performed during all interventional procedures, as well as during balloon occlusion of the ACI.