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Updated: Dec 29, 2025
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Functional Transcranial Doppler Ultrasound for Monitoring Cerebral Blood Flow
Published on: March 15, 2021
8.8K
Assessing Cerebrovascular Hemodynamics Using Transcranial Doppler in Patients with Mechanical Circulatory Support
Kara R Melmed1,2, Konrad H Schlick1, Brenda Rinsky1
1Department of Neurology and Comprehensive Stroke Center, Cedars-Sinai Medical Center, Los Angeles, CA.
Summary
Transcranial Doppler ultrasound reveals distinct hemodynamic patterns for mechanical circulatory support (MCS) devices. These device-specific TCD signatures are recognizable and reproducible, aiding in understanding blood flow in heart failure patients.
Area of Science:
- Cardiovascular Medicine
- Neurosonology
- Biomedical Engineering
Background:
- Mechanical circulatory support (MCS) devices are critical for managing advanced heart failure.
- MCS use is associated with increased risks of embolic and hemorrhagic stroke.
- Understanding hemodynamic compromise is crucial for mitigating stroke risk in MCS patients.
Purpose of the Study:
- To characterize the hemodynamics of various mechanical circulatory support (MCS) devices using transcranial Doppler (TCD) ultrasound.
- To compare hemodynamic waveforms generated by pulsatile and nonpulsatile MCS devices, including the total artificial heart (TAH).
- To identify device-specific TCD patterns for improved stroke risk assessment.
Main Methods:
- Prospective enrollment of 86 patients with MCS from February 2013 to December 2016.
- Performance of 132 transcranial Doppler (TCD) imaging studies.
- Analysis of TCD parameters: peak systolic velocity, end-diastolic velocity, pulsatility indices (PIs), and high-intensity transient signals; comparison of waveform morphologies across different MCS devices.
Main Results:
- Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) showed continuous flow with low pulsatility index (PI) (0.43 ± 0.2).
- Continuous-flow left ventricular assist devices (CF-LVADs) exhibited lower PIs (0.32 ± 0.13).
- Impella devices demonstrated pulsatile waveforms (PI 0.65 ± 0.24), intra-aortic balloon pumps showed pronounced diastolic upstrokes (PI 1.01 ± 0.16), and total artificial heart (TAH) patients had near-normal cerebral artery velocities and PIs (0.74 ± 0.14).
Conclusions:
- Transcranial Doppler (TCD) ultrasound effectively detects characteristic, device-specific hemodynamic waveforms in patients with mechanical circulatory support (MCS).
- These TCD patterns are recognizable and reproducible, offering valuable insights into blood flow dynamics.
- TCD can serve as a valuable tool for monitoring hemodynamics and potentially assessing stroke risk in MCS patients.
Keywords:
Transcranial Doppler ultrasoundheart failurehigh-intensity transient signalleft ventricular assist devicestrokeMore Related Videos
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