UCSD Comprehensive Stroke Center, Department of Neurosciences, University of California San Diego, San Diego, California, USA.
Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada.
J Neuroimaging. 2021 Sep;31(5):849-857. doi: 10.1111/jon.12887. Epub 2021 Jun 15.
Cerebral vessel recanalization therapy, either intravenous thrombolysis or mechanical thrombectomy, is the main treatment that can significantly improve clinical outcomes after acute ischemic stroke. The degree of recanalization and cerebral reperfusion of the ischemic penumbra are dependent on cerebral hemodynamics. Currently, the main imaging modalities to assess reperfusion are MRI and CT perfusion. However, these imaging techniques cannot predict reperfusion-associated complications and are not readily available in many centers. It is also not feasible to repeat them frequently for sequential assessments, which is important because of the changing nature of cerebral hemodynamics following stroke. Transcranial Doppler sonography (TCD) is a valid, safe, and inexpensive technique that can assess recanalized vessels and reperfused tissue in real-time at the bedside. Post thrombectomy reocclusion, hyperperfusion syndrome, distal embolization, and remote infarction result in poor outcomes after mechanical or intravenous reperfusion therapy. Managing blood pressure following these endovascular treatments can also be a dilemma. TCD has an important role, with major clinical implications, in evaluating cerebral hemodynamics and collateral vessel status, guiding clinicians in making individualized decisions based on cerebral blood flow during acute stroke care. This review summarizes the most relevant literature on the role of TCD in evaluating patients after reperfusion therapy. We also discuss the importance of performing TCD in the first few hours following thrombolytic therapy in identifying hyperperfusion syndrome and embolic signals, predicting recurrent stroke, and detecting reocclusions, all of which may help improve patient prognosis. We recommend TCD during the hyperacute phase of stroke in comprehensive stroke centers.
脑血管再通治疗，无论是静脉溶栓还是机械取栓，都是急性缺血性脑卒中后显著改善临床结局的主要治疗方法。缺血半暗带的再通程度和脑灌注依赖于脑血流动力学。目前，评估再灌注的主要影像学方法是 MRI 和 CT 灌注。然而，这些成像技术无法预测再灌注相关并发症，且在许多中心都无法应用。由于脑卒中后脑血流动力学的变化性质，也不可能频繁重复这些检查进行连续评估。经颅多普勒超声（TCD）是一种有效、安全、廉价的技术，可在床边实时评估再通血管和再灌注组织。机械或静脉再灌注治疗后发生血栓切除术后再闭塞、过度灌注综合征、远端栓塞和远处梗死，会导致预后不良。这些血管内治疗后血压管理也可能存在难题。TCD 在评估脑血流动力学和侧支血管状态方面具有重要作用，对指导临床医生根据急性脑卒中护理期间的脑血流做出个体化决策具有重要意义。这篇综述总结了 TCD 在评估再灌注治疗后患者中的作用的相关文献。我们还讨论了在溶栓治疗后数小时内进行 TCD 的重要性，以识别过度灌注综合征和栓塞信号，预测复发性卒中，并检测再闭塞，所有这些都可能有助于改善患者预后。我们建议在综合性卒中中心的卒中超急性期进行 TCD。
