Robotic Assisted Transcranial Doppler Monitoring in Acute Neurovascular Care: A Feasibility and Safety Study

Alvise Fattorello Salimbeni; Caterina Kulyk; Francesco Favruzzo; Ludovica De Rosa; Federica Viaro; Alessio Pieroni; Stefano Mozzetta; Milan R Vosko; Claudio Baracchini

doi:10.1007/s12028-024-02121-z

Robotic Assisted Transcranial Doppler Monitoring in Acute Neurovascular Care: A Feasibility and Safety Study

Neurocrit Care. 2024 Sep 19. doi: 10.1007/s12028-024-02121-z. Online ahead of print.

Affiliations

¹ Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy. a.fattorellosalimbeni@gmail.com.
² Stroke Unit and Neurosonology Laboratory, Department of Neurology, Kepler University Hospital GmbH, Johannes Kepler University, Linz, Austria.
³ Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy.

^# Contributed equally.

PMID: 39300038
DOI: 10.1007/s12028-024-02121-z

Abstract

Background: Transcranial color Doppler (TCD) is currently the only noninvasive bedside tool capable of providing real-time information on cerebral hemodynamics. However, being operator dependent, TCD monitoring is not feasible in many institutions. Robotic assisted TCD (ra-TCD) was recently developed to overcome these constraints. The aim of this study was to evaluate the safety and feasibility of cerebral monitoring with a novel ra-TCD in acute neurovascular care.

Methods: This is a two-center prospective study conducted between August 2021 and February 2022 at Padua University Hospital (Padua, Italy) and Kepler University Hospital (Linz, Austria). Adult patients with conditions impacting cerebral hemodynamics or patients undergoing invasive procedures affecting cerebral hemodynamics were recruited for prolonged monitoring (> 30 min) of the middle cerebral artery with a novel ra-TCD (NovaGuide Intelligent Ultrasound, NeuraSignal, Los Angeles, CA). Manual TCD was also performed for comparison by an experienced operator. Feasibility and safety rates were recorded.

Results: A total of 92 patients (age: mean 68.5 years, range 36-91; sex: male 57 [62%]) were enrolled in the two centers: 54 in Padua, 38 in Linz. The examination was feasible in the majority of patients (85.9%); the head cradle design and its radiopacity hindered its use during carotid endarterectomy and mechanical thrombectomy. Regarding safety, only one patient (1.1%) reported a minor local edema due to prolonged probe pressure. Velocity values were similar between ra-TCD and manual TCD.

Conclusions: This novel ra-TCD showed an excellent safety and feasibility and proved to be as reliable as manual TCD in detecting blood flow velocities. These findings support its wider use for cerebral hemodynamics monitoring in acute neurovascular care. However, further technical improvements are needed to expand the range of applicable settings.

Keywords: Artificial intelligence; Cerebral hemodynamics; Feasibility; Neuromonitoring; Robotic; Safety; Transcranial ultrasound.