Wearable Ultrasound for Autoregulation-Guided Hemodynamic Management after Endovascular Thrombectomy: A Digital
Anton Peled1, Karol P Budohoski1, Sarah Menacho1
1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA.
Background:
Hemodynamic management after endovascular thrombectomy (EVT) for patients with acute ischemic stroke from large vessel occlusions (LVOs) is a critical and unsolved challenge: four major randomized controlled trials that applied fixed systolic blood pressure (SBP) targets yielded neutral or harmful results, and the 2026 American Heart Association guideline cautions against aggressive SBP reduction below 140 mm Hg in the early post-EVT period. Independent physiological data demonstrate that cerebral autoregulation is profoundly and heterogeneously impaired after LVO stroke, suggesting that population-level fixed thresholds may be intrinsically mismatched to the biological diversity of autoregulatory states across individual patients.
Summary:
Continuous, personalized monitoring of cerebral autoregulation offers a precise alternative to uniform blood pressure targets. Current post-EVT hemodynamic management is reactive: blood pressure is measured intermittently, population-level thresholds are applied regardless of individual physiology, and clinical deterioration is often recognized only after secondary injury has occurred. Near-infrared spectroscopy-based computation of the cerebral oximetry index enables real-time derivation of each patient's optimal mean arterial pressure and autoregulatory limits, but current monitoring platforms are confined to specialized research settings. This review examines how recent advances in wearable ultrasound engineering, including conformal transcranial patches, wireless integrated systems, and low-cost disposable devices, create the technical foundation for portable, scalable cerebral hemodynamic monitoring with the potential to extend personalized autoregulation-guided care from specialized academic centers to community hospitals and broader stroke networks.
Key Messages:
(1) The failure of four randomized trials to identify a uniform post-EVT blood pressure target, together with evidence of heterogeneous autoregulation impairment after LVO stroke, motivates a shift toward personalized, autoregulation-guided management. (2) Emerging wearable ultrasound technology offers a credible technical pathway to continuous transcranial hemodynamic monitoring, with an engineering profile suited to deployment in community hospitals and broader stroke networks beyond specialized research centers. (3) Integrating wearable sensing, computational autoregulation analysis, and digital health infrastructure could enable a proactive, precision-guided model of post-EVT care, contingent on prospective clinical validation.
