Transcranial Doppler for Bedside Assessment of Cerebral Hemodynamics following Mechanical Thrombectomy in Cerebral Venous Thrombosis: A Prospective Observational Feasibility Case Series from a Low- and Middle-Income Country

BACKGROUND: Cerebral venous thrombosis (CVT) represents an uncommon yet potentially reversible form of stroke, predominantly affecting young adults. Mechanical thrombectomy (MT) is increasingly used in patients with extensive thrombus burden or medically refractory cases. In low- and middle-income countries (LMICs), where repeated neuroimaging may not be readily feasible, transcranial Doppler (TCD) ultrasonography offers a non-invasive, bedside, and low-cost approach to assess cerebral hemodynamics. Its role in CVT remains underexplored. OBJECTIVE: To evaluate the changes in middle cerebral artery (MCA) flow velocities measured by TCD ultrasonography in patients with CVT at baseline, day 1, and day 2 following MT. METHODS: Fourteen patients (15-60 years) with magnetic resonance venography-confirmed CVT undergoing MT were prospectively studied. Bilateral MCA peak systolic velocity (PSV), mean flow velocity (MFV), end-diastolic velocity (EDV), and pulsatility index (PI) were recorded at baseline and on days 1 and 2 postprocedure. Serial MCA flow parameters across baseline, day 1 and day 2 were compared using repeated-measures analysis of variance, with paired t-tests for pre-specified comparisons against baseline (confirmed by Wilcoxon signed-rank tests); a two-sided P < 0.05 was considered significant. RESULTS: We observed a predominantly young male cohort (57%) of mean age 34.4 ± 11 years. Venous involvement was left (42.8%), right (42.8%), or bilateral (14.2%), with raised intracranial pressure in 78.6%. No significant MCA flow changes occurred on day 1. By day 2, right MCA EDV showed a decreasing trend, though statistically not significant (P = 0.06). Other parameters, such as PSV, MFV, and PI, showed non-significant trends. The left MCA parameters remained stable. CONCLUSION: TCD assessment of the MCA may have limited sensitivity in detecting early hemodynamic changes following MT in CVT. Larger prospective studies with longer follow-up durations are needed to better define the role of TCD in this setting.