Collaterals and TCD

“TCD to evaluate postreperfusion therapy following acute ischemic stroke: A literature review” by Shahripour RB, Azarpazhooh MR, Akhuanzada H, Labin E, Borhani-Haghighi A, Agrawal K, Meyer D, Meyer B, Hemmen TM. J Neuroimaging. 2021;1–9. https://lnkd.in/dfjJcpTw Since the thrombectomy window has been extended to 24 hours from 6 hours based on the recent 2018 American Heart Association guidelines, the role of collaterals in the initial hours after stroke is more pivotal in stroke outcomes. Clinical challenges in acute ischemic stroke care include predicting recanalization success following intravenous thrombolysis. TCD can help clinicians understand the course and success of recanalization, with an accurate measure of residual TIBI grade flow at the site of LVO. During the early hours after thrombectomy, TCD can provide valuable information for managing patients in neurocritical care units. Important clinical implications include predicting post thrombectomy complications, such as hemorrhagic transformation, stroke recurrence, and possible re-occlusion. Early TCD assessments may also inform individual blood pressure management specific to each patient’s flow dynamics. Limitations in TCD use include training requirements, inter-operator variability, and an absence of a sufficient transtemporal acoustic window in 10-15% of patients.