Knowledge of vascular status for therapeutic decision-making in acute ischemic stroke: which is the role of neurosonology?

In the last years there is an increasing interest in the knowledge of vascular status in patients with acute stroke. Detection and localization of an artery occlusion is of great interest for an accurate prognosis and the selection of the most appropriate recanalizing therapy. Neurosonology is a useful diagnostic tool for vascular status study in patients with acute stroke. Different situations where ultrasounds offer a valuable diagnostic information are reviewed, such as middle cerebral artery (MCA) occlusion, 'T' internal carotid artery (ICA) occlusion, 'tandem' ICA-MCA occlusion, monitoring of intracranial artery occlusions, acute occlusion of extracranial ICA, and free-floating thrombus in the ICA. Neurosonology offers evident advantages compared with other diagnostic techniques: it is faster, dynamic, cheaper, harmless, and accessible, allows real-time monitoring of patients vascular status, avoids delays in acute treatments and has a therapeutic effect (sonothrombolysis). Neurosonology has an essential role in the diagnosis of vascular status and in therapeutic decision-making of acute ischemic stroke patients.