The Value of Transcranial Doppler Sonography With a Transorbital Approach in the Confirmation of Cerebral Circulatory Arrest T. Soldatos, D. Karakitsos, M. Wachtel, J. Boletis, K. Chatzimichail, M. Papathanasiou, A. Gouliamos, and A. Karabinis ABSTRACT Objective. Transcranial Doppler sonography (TCD) provides accurate confirmation of cerebral circulatory arrest (CCA) in brain death (BD), but is not feasible in patients with absent temporal bone windows. We added the transorbital approach in the TCD protocol for the diagnosis of CCA and compared findings with angiography. Furthermore, we evaluated whether reporting the angiographic and sonographic confirmation of CCA to relatives of brain-dead patients improves their comprehension and satisfaction with the medical information. Patients and Methods. Eighty-two clinically brain-dead patients underwent 4-vessel angiography, TCD of the basilar and middle cerebral arteries, and transorbital Doppler sonography (TOD) of the internal carotid arteries. Relatives were randomly allocated to 41 in whom BD was presented as a clinical diagnosis (group A) and to 41 in whom BD was presented as a clinical diagnosis confirmed by TCD and angiography (group B). Compre- hension and satisfaction of the relatives were assessed using an interview and a question- naire. Results. Both angiography and TCD verified CCA in all cases (k = 1). In 11 patients with failure of the transtemporal approach, CCA was confirmed by the transorbital recordings. The addition of TOD enabled 15.5% more cases of CCA to be diagnosed by TCD. Group B exhibited improved comprehension and satisfaction rates (P  .05). Conclusions. The addition of TOD increases the efficacy of TCD in confirming CCA in BD. Reporting confirmation of CCA to families of brain-dead patients may improve their comprehension and satisfaction with the provided medical information. B RAIN death (BD), which is defined as the irreversible cessation of all brain functions, is characterized by the arrest of cerebral circulation. 1 The diagnosis of BD is based on clinical examination, while adjunctive tests may be used to verify cerebral circulatory arrest (CCA). In a previous report, we confirmed the accuracy of transcranial Doppler sonography (TCD) to confirm CCA in BD, but excluded subjects with absent temporal bone windows (ABW). 2 This is a limitation of TCD, which occurs in about 10% of patients, precluding evaluation of the anterior cerebral circulation, thereby rendering TCD confirmation of CCA unfeasible. 3–5 Hence, we evaluated whether the addition of the transorbital examination of the anterior cerebral circu- lation improved the accuracy of TCD to detect CCA in brain-dead patients. The findings of the extended TCD protocol were compared with angiography. Finally, we investigated whether reporting the sonographic and angio- graphic confirmation of CCA to relatives of brain-dead patients might improve their comprehension and/or satis- faction with the medical information. PATIENTS AND METHODS Patients This prospective study was performed from 2004 –2009 in a cohort of 90 consecutive intensive care unit (ICU) patients with clinically established BD. All patients were continuously monitored for From the Department of Radiology and Imaging G. Gennima- tas General State Hospital, Athens, Greece. Address reprint requests to Theodoros Soldatos, MD, G. Gennimatas General State Hospital, 154 Mesogeion Ave, Ath- ens, Greece. 0041-1345/10/$–see front matter © 2010 Published by Elsevier Inc. doi:10.1016/j.transproceed.2010.01.074 360 Park Avenue South, New York, NY 10010-1710 1502 Transplantation Proceedings, 42, 1502–1506 (2010)