Diagnostic Accuracy of Transcranial Doppler Ultrasonography in Predicting Cerebral Hyperperfusion Syndrome Following Carotid Revascularization: A Systematic Review and Meta-analysis

Document Type

Conference Proceeding

Publication Date

1-29-2026

Publication Title

Stroke

Keywords

Intracerebral hemorrhage, Stroke, Ultrasound, Vascular

Abstract

Background: Cerebral hyperperfusion syndrome (CHS) after carotid revascularization procedures, such as carotid artery stenting (CAS) and carotid endarterectomy (CEA), is a well-described and serious complication. Predicting which patients are most likely to experience CHS utilizing transcranial doppler (TCD) ultrasonography remains uncertain. We aimed to conduct a systematic review and meta-analysis in order to assess the diagnostic accuracy of TCD-related parameters in predicting CHS after carotid interventions. Methods: We conducted a systematic search of PubMed, EMBASE, and Web of Science from inception to July 12, 2025, and performed a meta-analysis to evaluate the role of TCD-related parameters obtained pre- and post-intervention in predicting CHS. Articles evaluating the diagnostic accuracy of TCD studies in predicting CHS in adult patient population undergoing CEA or CAS were included. We utilized a bivariate random-effects model to assess the diagnostic accuracy of TCD parameters and performed the review according to the Preferred Reported Items for Systematic and Meta-analyses (PRISMA) guidelines. Results: Of the 3571 initially identified studies, 15 studies of 5160 patients met the inclusion criteria. Pooled analysis demonstrated that a two-fold increase in the mean flow velocity (MFV) of the ipsilateral middle cerebral artery (MCA) following carotid intervention was associated with an overall sensitivity of 56% (95% confidence interval [CI], 31%-79%, I2=66.2%) and specificity of 93% (95% CI, 86%-96%, I2=66.2%73.4%) for predicting CHS. Moreover, a two-fold increase of ipsilateral peak systolic velocity (PSV) of the MCA demonstrated sensitivity of 54% (95% CI, 26%-79%, I2=46.8%) and specificity of 97% (95% CI, 90%-99%, I2=72.1%). Across the studies, negative predictive value ranged between 95-100% for the aforementioned metrics. A one-fold increase in MCA MFV demonstrated a sensitivity of 88% (95% CI, 68%-96%) and specificity of 81% (95% CI, 74%-86%). In subgroup analysis restricted to patients undergoing CEA, a two-fold increase in MCA MFV yielded sensitivity of 88% (95% CI, 68%-96%) and specificity of 92% (95% CI, 86%-96%). Conclusions: After carotid revascularization procedure, absence of a two-fold increase in MCA MFV or PSV on TCD strongly indicates that CHS is unlikely to occur. However, the modest sensitivity reduces the usefulness of this technique as an early screening tool.

Volume

57

Issue

SUPPL_1

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