Role of diagnostic ultrasound in patient selection for stroke intervention

Ultrasonography provides a unique diagnostic perspective in cerebrovascular disorders, with extremely high temporal resolution and excellent spatial display of extracranial as well as intracranial arteries. Unlike other imaging modalities, cerebrovascular ultrasound provides real-time information about the blood flow in addition to the hemodynamic changes as a result of various physiological as well as pathological states. The information obtained from cerebrovascular ultrasound has diagnostic, therapeutic as well as prognostic value in various disease states. Transcranial Doppler ultrasonography (TCD) is the only non-invasive examination that provides a reliable evaluation of intracranial blood flow patterns in real-time, adding physiological information to the anatomical information obtained from other neuroimaging modalities. Cerebrovascular ultrasonography is relatively cheap, can be performed bedside, and allows monitoring both in acute emergency settings as well as for prolonged periods with a high temporal resolution. Extended applications of TCD provide important information about the pathophysiology of cerebrovascular ischemia. Advanced applications of cerebrovascular ultrasonography have become an integral part of the armamentarium of stroke neurologists for evaluating stroke mechanisms, plan and monitor treatment and determine prognosis. It has been suggested as an essential component of a comprehensive stroke center. We have reviewed various recent patents in addition to the established applications of cerebrovascular ultrasonography in patient selection for various stroke interventions.