Objective:

To systematically evaluate the utility of transcranial Doppler (TCD) ultrasound in the management of patients hospitalized with acute ischemic stroke (AIS) syndrome, by performing a systematic literature review and meta-analysis.

Background:

TCD is a cost-effective technology that can be applied in patients with AIS amenable to time-sensitive reperfusion therapies to guide acute management. To inform future practice, we investigated the diagnostic and prognostic utility of TCD in AIS patients that received intravenous thrombolysis (IVT) or endovascular reperfusion therapies (EVT).

Design/Methods:

Using Meta-analyses of Observational Studies in Epidemiology guidelines, we searched 5 databases through 2022, for studies reporting the use of TCD in AIS. Studies were included if patients received reperfusion therapy (IVT, EVT, both) and underwent TCD either upon presentation to the Emergency Department or during their hospital stay. We recorded time from AIS onset to TCD investigation, time from revascularization therapy to TCD, TCD type, vessels insonated and their mean flow velocities and pulsatility indices, neurological outcome, mortality. We adjusted for study quality and heterogeneity.

Results:

Out of 850 abstracts/manuscripts reviewed, 119 were included in the qualitative analysis. 74.7% studied TCD in AIS after IVT, 10.9% after EVT, and 14.3% after combined IVT and EVT. Identification of the arterial occlusion site was the main indication for TCD in IVT (77.8%), EVT (30.8%), and combined treatment (70.6%). TCD was used to assess the vessel recanalization, that correlated with neurological status at 24 hours (National Institute of Health Stroke Scale score) and 3-month neurological outcome (modified Rankin score) after IVT (33.3% and 38.9%), EVT (15.4% and 7.7%) and mixed therapy (23.4% and 29.4%).

Conclusions:

TCD can accurately identify arterial steno-occlusive disease and monitor recanalization after reperfusion therapies, which correlate with neurological outcome. Insufficiency of temporal acoustic windows and technologists’ availability limit widespread TCD application in routine evaluation of AIS patients.