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.

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经颅多普勒评估急性缺血性卒中后的再灌注治疗：文献综述

脑血管再通治疗，无论是静脉溶栓还是机械取栓，是可以显着改善急性缺血性卒中后临床结果的主要治疗方法。缺血半暗带的再通和脑再灌注程度取决于脑血流动力学。目前，评估再灌注的主要成像方式是 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，并且在许多中心并不容易获得。在连续评估中频繁重复它们也是不可行的，这很重要，因为中风后脑血流动力学的性质会发生变化。经颅多普勒超声 (TCD) 是一种有效、安全、以及可以在床边实时评估再通血管和再灌注组织的廉价技术。血栓切除术后再闭塞、高灌注综合征、远端栓塞和远端梗死导致机械或静脉再灌注治疗后的不良结果。在这些血管内治疗后管理血压也可能是一个难题。TCD 在评估脑血流动力学和侧支血管状态、指导临床医生在急性卒中护理期间根据脑血流量做出个性化决定方面具有重要作用，具有重要的临床意义。本综述总结了关于 TCD 在评估再灌注治疗后患者中的作用的最相关文献。我们还讨论了在溶栓治疗后的最初几个小时内进行 TCD 在识别高灌注综合征和栓塞信号、预测卒中复发和检测再闭塞方面的重要性，所有这些都可能有助于改善患者预后。我们推荐在综合卒中中心的卒中超急性期进行 TCD。