{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T17:48:39Z","timestamp":1792259319335,"version":"4.4.0"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) is typically diagnosed using CT or catheter angiography, both of which involve radiation exposure, iodinated contrast agent administration, and the transfer of critically unwell patients to the radiology department. Transcranial Doppler (TCD) ultrasound offers a bedside radiation-free alternative, but concerns regarding diagnostic performance have limited widespread use. The aim of this study was to assess whether routine TCD monitoring in patients with aSAH influenced the incidence of delayed cerebral ischemia (DCI) and long-term functional outcomes.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This retrospective single-institution study analyzed patients who were treated for aSAH before (2019\u20132020) and after (2021\u20132022) the introduction of routine TCD monitoring. Clinicodemographic data were analyzed, with propensity score matching and multivariable regression used to control for confounders. The primary outcome was the modified Rankin Scale (mRS) score at 6 months, with DCI incidence as a secondary outcome.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Of 466 patients (305 female, mean age 56.6 years) included in this analysis, 239 were in the pre-TCD group and 227 were in the post-TCD group. Baseline demographics and comorbidities were similar between the groups, as was the 6-month favorable functional outcome (mRS scores 0\u20132; 74.5% vs 73.6%, p = 0.906). However, following propensity score matching, routine TCD monitoring was found to be associated with reduced odds of poor outcome (matched OR 0.50, p = 0.010). The incidence of DCI was lower in the post-TCD cohort (18.1% vs 25.5%) and multivariable analysis confirmed a protective effect of routine TCD monitoring on the incidence of DCI (OR 0.48, p = 0.004). Counterfactual analysis indicated an absolute risk reduction for clinical DCI of 5.3% (p = 0.026) and relative risk reduction of 18.7% in association with the use of TCD.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The implementation of routine TCD monitoring was associated with improved functional outcomes and a reduced incidence of DCI in patients with aSAH. These findings support routine TCD use for early vasospasm detection and timely intervention, but require prospective multicenter validation.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.9.jns251710","type":"journal-article","created":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T01:47:42Z","timestamp":1770428862000},"page":"1324-1333","source":"Crossref","is-referenced-by-count":2,"title":["Impact of transcranial Doppler on the management of delayed cerebral ischemia: a propensity-matched analysis"],"prefix":"10.3171","volume":"144","author":[{"given":"Lana","family":"Al-Nusair","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Kouli","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saniya","family":"Ansari","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Carey","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Farhad","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Ali","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Nunn","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Lakhani","sequence":"additional","affiliation":[{"name":"Neuroanaesthesia, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathal John","family":"Hannan","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jawad","family":"Yousaf","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Stroke","first-page":"660","article-title":"Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review","volume":"28","author":"Hop JW","year":"1997","unstructured":"Hop JW, Rinkel GJ, Algra A, van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997;28(3):660\u2013664."},{"issue":"19","key":"b2","series-title":"Neurology","first-page":"1494","article-title":"Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review","volume":"74","author":"Lovelock CE","year":"2010","unstructured":"Lovelock CE, Rinkel GJE, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review. Neurology. 2010;74(19):1494\u20131501."},{"key":"b3","series-title":"Front Cardiovasc Med","first-page":"752769","article-title":"Delayed cerebral ischemia after subarachnoid hemorrhage: is there a relevant experimental model? A systematic review of preclinical literature","volume":"8","author":"Goursaud S","year":"2021","unstructured":"Goursaud S, Martinez de Lizarrondo S, Grolleau F, Delayed cerebral ischemia after subarachnoid hemorrhage: is there a relevant experimental model? A systematic review of preclinical literature. Front Cardiovasc Med. 2021;8:752769."},{"issue":"4","key":"b4","series-title":"Stroke","first-page":"562","article-title":"Cerebral vasospasm following aneurysmal subarachnoid hemorrhage","volume":"16","author":"Kassell NF","year":"1985","unstructured":"Kassell NF, Sasaki T, Colohan AR, Nazar G. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke. 1985;16(4):562\u2013572."},{"issue":"11","key":"b5","series-title":"Stroke","first-page":"3015","article-title":"Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial","volume":"39","author":"Macdonald RL","year":"2008","unstructured":"Macdonald RL, Kassell NF, Mayer S, Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. 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AJNR Am J Neuroradiol. 2014;35(12):2209\u20132214."},{"issue":"2","key":"b7","series-title":"Stroke","first-page":"333","article-title":"Predictors of in-hospital death after aneurysmal subarachnoid hemorrhage: analysis of a nationwide database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage])","volume":"49","author":"Stienen MN","year":"2018","unstructured":"Stienen MN, Germans M, Burkhardt JK, Predictors of in-hospital death after aneurysmal subarachnoid hemorrhage: analysis of a nationwide database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]). Stroke. 2018;49(2):333\u2013340."},{"issue":"10","key":"b8","series-title":"Stroke","first-page":"2292","article-title":"Transcranial Doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm: a systematic review","volume":"32","author":"Lysakowski C","year":"2001","unstructured":"Lysakowski C, Walder B, Costanza MC, Tram\u00e8r MR. 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Association between transcranial Doppler vasospasm and functional outcome after subarachnoid hemorrhage. Brain Circ. 2021;7(4):271\u2013276."},{"issue":"7","key":"b23","series-title":"J Clin Neurosci","first-page":"950","article-title":"The role of transcranial Doppler ultrasound monitoring in patients with aneurysmal subarachnoid haemorrhage","volume":"19","author":"Deb S","year":"2012","unstructured":"Deb S, Gogos AJ, Drummond KJ, Teddy PJ. The role of transcranial Doppler ultrasound monitoring in patients with aneurysmal subarachnoid haemorrhage. J Clin Neurosci. 2012;19(7):950\u2013955."},{"key":"b24","series-title":"Acta Neurochir Suppl","first-page":"207","article-title":"The Hawthorne effect: quality and outcomes in neurosurgery","volume":"130","author":"Pande A","year":"2023","unstructured":"Pande A, Ghosh S. The Hawthorne effect: quality and outcomes in neurosurgery. Acta Neurochir Suppl. 2023;130:207\u2013216."},{"issue":"3","key":"b1","series-title":"Stroke","first-page":"660","article-title":"Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review","volume":"28","author":"Hop JW","year":"1997","unstructured":"Hop JW, Rinkel GJ, Algra A, van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997;28(3):660\u2013664."},{"issue":"19","key":"b2","series-title":"Neurology","first-page":"1494","article-title":"Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review","volume":"74","author":"Lovelock CE","year":"2010","unstructured":"Lovelock CE, Rinkel GJE, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review. Neurology. 2010;74(19):1494\u20131501."},{"key":"b3","series-title":"Front Cardiovasc Med","first-page":"752769","article-title":"Delayed cerebral ischemia after subarachnoid hemorrhage: is there a relevant experimental model? A systematic review of preclinical literature","volume":"8","author":"Goursaud S","year":"2021","unstructured":"Goursaud S, Martinez de Lizarrondo S, Grolleau F, Delayed cerebral ischemia after subarachnoid hemorrhage: is there a relevant experimental model? A systematic review of preclinical literature. Front Cardiovasc Med. 2021;8:752769."},{"issue":"4","key":"b4","series-title":"Stroke","first-page":"562","article-title":"Cerebral vasospasm following aneurysmal subarachnoid hemorrhage","volume":"16","author":"Kassell NF","year":"1985","unstructured":"Kassell NF, Sasaki T, Colohan AR, Nazar G. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke. 1985;16(4):562\u2013572."},{"issue":"11","key":"b5","series-title":"Stroke","first-page":"3015","article-title":"Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial","volume":"39","author":"Macdonald RL","year":"2008","unstructured":"Macdonald RL, Kassell NF, Mayer S, Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke. 2008;39(11):3015\u20133021."},{"issue":"12","key":"b6","series-title":"AJNR Am J Neuroradiol","first-page":"2209","article-title":"Delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: proposal of an evidence-based combined clinical and imaging reference standard","volume":"35","author":"Sanelli PC","year":"2014","unstructured":"Sanelli PC, Kishore S, Gupta A, Delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: proposal of an evidence-based combined clinical and imaging reference standard. AJNR Am J Neuroradiol. 2014;35(12):2209\u20132214."},{"issue":"2","key":"b7","series-title":"Stroke","first-page":"333","article-title":"Predictors of in-hospital death after aneurysmal subarachnoid hemorrhage: analysis of a nationwide database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage])","volume":"49","author":"Stienen MN","year":"2018","unstructured":"Stienen MN, Germans M, Burkhardt JK, Predictors of in-hospital death after aneurysmal subarachnoid hemorrhage: analysis of a nationwide database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]). Stroke. 2018;49(2):333\u2013340."},{"issue":"10","key":"b8","series-title":"Stroke","first-page":"2292","article-title":"Transcranial Doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm: a systematic review","volume":"32","author":"Lysakowski C","year":"2001","unstructured":"Lysakowski C, Walder B, Costanza MC, Tram\u00e8r MR. Transcranial Doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm: a systematic review. Stroke. 2001;32(10):2292\u20132298."},{"issue":"4","key":"b9","series-title":"Stroke","first-page":"1082","article-title":"Quality of life and healthcare resource use associated with angiographic vasospasm after aneurysmal subarachnoid hemorrhage","volume":"43","author":"Macdonald RL","year":"2012","unstructured":"Macdonald RL, Hunsche E, Sch\u00fcler R, Wlodarczyk J, Mayer SA. Quality of life and healthcare resource use associated with angiographic vasospasm after aneurysmal subarachnoid hemorrhage. Stroke. 2012;43(4):1082\u20131088."},{"issue":"13","key":"b10","series-title":"J Clin Med","first-page":"3743","article-title":"Agreement between CT-angiography and digital subtraction angiography in predicting angiographic vasospasm in patients with subarachnoid hemorrhage","volume":"13","author":"Moser MM","year":"2024","unstructured":"Moser MM, Gramss L, Marik W, Agreement between CT-angiography and digital subtraction angiography in predicting angiographic vasospasm in patients with subarachnoid hemorrhage. J Clin Med. 2024;13(13):3743."},{"issue":"5","key":"b11","series-title":"J Neurosurg","first-page":"1257","article-title":"Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis","volume":"124","author":"Kumar G","year":"2016","unstructured":"Kumar G, Shahripour RB, Harrigan MR. Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg. 2016;124(5):1257\u20131264."},{"issue":"7","key":"b12","series-title":"Stroke","first-page":"e314","article-title":"2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association\/American Stroke Association","volume":"54","author":"Hoh BL","year":"2023","unstructured":"Hoh BL, Ko NU, Amin-Hanjani S, 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association\/American Stroke Association. Stroke. 2023;54(7):e314\u2013e370."},{"issue":"10","key":"b13","series-title":"Stroke","first-page":"2391","article-title":"Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group","volume":"41","author":"Vergouwen MDI","year":"2010","unstructured":"Vergouwen MDI, Vermeulen M, van Gijn J, Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. 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