To investigate the application value of transcranial Doppler ultrasound (TCD) in postoperative management of patients with acute anterior circulation large vessel occlusive stroke undergoing mechanical thrombectomy.

A retrospective analysis was performed on 80 patients with acute anterior circulation cerebral infarction who underwent successful mechanical thrombectomy at Xiaogan Hospital affiliated to Wuhan University of Science and Technology from May 2021 to January 2024. Within 24 hours postoperatively, TCD was used to assess the peak systolic velocity (PSV), end diastolic velocity (EDV), mean flow velocity (MFV), and pulsatility index (PI) of the affected hemisphere. Patients were categorized into increased flow velocity group (n=31) and normal flow velocity group (n=49) based on whether the ipsilateral PSV exceeded the contralateral side by >30%. Univariate analysis (χ² test, independent sample t test and rank sum test) was used to compare the differences between the two groups, and multivariate binary Logistic regression was used to identify independent predictors of increased ipsilateral blood flow velocity.

There were statistically significant differences between the increased flow velocity group and the normal flow velocity group in terms of the proportion of aspiration combined with stent thrombectomy [87.75% vs 67.74%; χ²=4.753, P=0.029], postoperative cerebral hemorrhage rate [4.08% vs 25.81%; χ²=8.193, P=0.004], affected side PSV [(100.76±9.84) cm/s vs (119.61±16.71) cm/s; t=5.690, P<0.001], contralateral side PSV [(90.55±8.70) cm/s vs (85.16±11.15) cm/s; t=2.287, P=0.026], affected side EDV [(39.73±4.67) cm/s vs (43.65±5.81) cm/s; t=3.318, P=0.018], contralateral side EDV [(35.71±3.95) cm/s vs (33.19±4.25) cm/s; t=2.700, P=0.008], affected side MFV [(60.08±6.64) cm/s vs (69.99±8.48) cm/s; t=5.655, P<0.001], contralateral side MFV [(54.02±4.81) cm/s vs (50.45±6.13) cm/s; t=2.905, P=0.005], affected side PI (1.02±0.11 vs 1.10±0.13; t=3.022, P=0.003), and the proportion of patients with an mRS score ≤2 at discharge 90 days (73.47% vs 48.39%; χ²=5.169, P=0.023). Multiple binary Logistic regression analysis, after adjusting for related factors, indicated that aspiration combined with stent thrombectomy was negatively correlated with the increase of blood flow velocity on the lesion side (β=-1.395, P=0.024), while postoperative cerebral hemorrhage was positively correlated with the blood flow velocity on the lesion side (β=1.898, P=0.031).

TCD can provide real-time monitoring of cerebral hemodynamic information following mechanical thrombectomy, which can be used for bedside guidance in personalized perioperative management. An increased PSV postoperatively suggests the possibility of hyperperfusion syndrome or cerebral hemorrhage in patients.