Transcranial Doppler Monitoring After Mechanical Thrombectomy: Pros and Cons

The acute ischemic stroke code that culminates in mechanical thrombectomy (MT) is accompanied by a significant amount of neuroimaging-CT head, CT angiogram of the head and neck, often a CT perfusion, and then the conventional angiogram performed by the neuroendovascular specialist. Immediately postprocedurally, patients who have undergone MT are at risk for reocclusion, hemorrhagic conversion of stroke, and malignant cerebral edema. While CT and MR imaging provide static images, transcranial Doppler (TCD) is becoming more commonly used to evaluate cerebral hemodynamics post-MT and screen for potential complications. Here, we outline the arguments for and against routine performance of TCD in the immediate post-MT phase of care.