Transcranial Doppler in Neurointervention: Applications in Endovascular Thrombectomy and Carotid Artery Stenting

Abstract

Recent advances in neurointerventional strategies, including the endovascular thrombectomy (EVT) and carotid artery stenting (CAS) techniques, have revolutionized ischemic stroke management by expanding treatment options and improving patient outcomes. Conventional transcranial Doppler (TCD), a tool long used in stroke care, lacks the ability to directly visualize vessels, limiting its application. However, TCD is still valuable as a non-invasive adjunctive monitoring strategy in neurointervention, owing to its ability to provide continuous, real-time bedside hemodynamic monitoring, offering precise numerical data, high repeatability, low invasivity, and no risk of radiation or contrast agent exposure. This unique capacity for continuous monitoring is particularly useful when integrated with artificial intelligence (AI) for data interpretation. This review explored the potential of TCD as an adjunct tool in neurointervention, emphasizing its roles in EVT and CAS. In EVT, TCD aids to evaluate post-recanalization blood flow, predicting clinical outcomes by assessing cerebral autoregulation and collateral status, and identifying patients at risk of hyperperfusion syndrome. TCD can further aid in stroke risk assessment in patients with asymptomatic carotid stenosis, as well as the selection of candidates for CAS by detecting microemboli, assessing the cerebrovascular reserve, and evaluating ophthalmic artery flow reversal. It can also be used to detect cerebral hyperperfusion following CAS. The utility of TCD extends to other endovascular procedures beyond neurointerventions, where automated and AI-assisted devices enhance its real-time intraoperative neuromonitoring abilities. This review discusses the potential of TCD to refine patient selection, predict outcomes, and enhance the efficacy of neurointerventional procedures.