Transcranial Doppler Monitoring of Acute Reperfusion Therapies in Acute Ischemic Stroke Patients with Underlying Large Vessel Occlusions

Abstract

Large vessel occlusion accounts for up to 20% of ischemic strokes. Intravenous thrombolysis and mechanical thrombectomy are two effective and complementary reperfusion therapies of acute ischemic stroke, the former exclusively applicable in patients with large vessel occlusions. Real-time, continuous monitoring of acute reperfusion therapies is only feasible with the application of transcranial Doppler (TCD) and transcranial color-coded duplex (TCCD) sonography. TCD is a bedside, easily repeatable examination that can provide with important information regarding the localization of occlusion and degree of residual flow, collateral status, real time embolization, recanalization timing and persistent target vessel patency. TCCD may also identify the presence of intracranial bleeding complicating intravenous thrombolysis or mechanical thrombectomy. TCD or TCCD monitoring of reperfusion therapies can be conducted in the emergency room, in the stroke unit and the angiography suite. In the current era of acute ischemic stroke management, TCD and TCCD do not replace other static angiographic imaging modalities but represent easily repeatable, radiation-free, bedside examinations that may disclose additional data strongly correlating with clinical outcomes which may eventually influence treatment decisions.