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Updated: Nov 29, 2025
Functional Transcranial Doppler Ultrasound for Monitoring Cerebral Blood Flow
Published on: March 15, 2021
A Review of the use of Transcranial Doppler Waveform Morphology for Acute Stroke Assessment
Amber Y Dorn1, Samuel G Thorpe1, Nicolas Canac1
1NovaSignal Corp., Los Angeles, CA, United States.
Insights
Acute ischemic stroke from large vessel occlusion (LVO) is disabling. Morphological analysis of transcranial Doppler (TCD) ultrasound waveforms is evolving to improve assessment and monitoring of LVO stroke treatments.
Area of Science:
- Neurology
- Medical Imaging
- Cerebrovascular Disease
Background:
- Acute ischemic stroke, particularly large vessel occlusion (LVO), causes significant long-term disability and mortality.
- Current treatment efficacy for LVO stroke is improving, necessitating advancements in diagnostic assessment.
- Transcranial Doppler (TCD) ultrasound offers non-invasive hemodynamic assessment but faces challenges in acute stroke workflows due to reliance on expert interpretation.
Purpose of the Study:
- To review the advancements in morphological analysis of transcranial Doppler (TCD) waveforms.
- To highlight the role of TCD waveform analysis in the assessment and monitoring of acute large vessel occlusion (LVO) stroke.
- To discuss the integration of TCD analysis into acute stroke management protocols.
Main Methods:
- Review of the evolution of transcranial Doppler (TCD) waveform morphological analysis techniques.
- Examination of studies focusing on TCD for indication, localization, and monitoring of acute LVO.
- Analysis of the transition from expert-dependent TCD interpretation to more standardized methods.
Main Results:
- Morphological analysis of TCD waveforms has progressed significantly, offering insights into cerebral hemodynamics.
- TCD waveform patterns can aid in the indication, precise localization, and real-time monitoring of recanalization in LVO stroke.
- Despite advancements, widespread adoption in acute stroke workflows is hindered by the need for expert analysis.
Conclusions:
- Evolving morphological analysis of TCD waveforms shows promise for improving acute LVO stroke assessment.
- Standardized TCD analysis could enhance its utility in guiding and monitoring interventions for LVO stroke.
- Further development and validation are needed to fully integrate TCD into routine acute stroke care.
Abstract:
Acute ischemic stroke is a source of long-term disability in the United States, of which a large portion of cases are a result of large vessel occlusion (LVO). LVO strokes have high rates of morbidity and mortality due to difficulty of treatments in achieving recanalization. Recently, however, results of randomized clinical trials have shown that treatment options are expanding in both availability and efficacy. As these methods of intervention become more optimal, so must the preceding methods of assessment. Transcranial Doppler (TCD) ultrasound is a non-invasive method of evaluating cerebral hemodynamics, and has a long history in stroke assessment. Despite the importance of information provided by a TCD exam, its utilization in the acute stroke workflow has remained low because of its dependence on expert analysis. Here, we review the evolution of morphological analysis of TCD waveforms for the indication, localization, and monitoring of acute LVO.
