A Review of the use of Transcranial Doppler Waveform Morphology for Acute Stroke Assessment

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.