Wearable Ultrasound for Autoregulation-Guided Hemodynamic Management After Endovascular Thrombectomy: A Digital Revolution for Post-Stroke Care.

BACKGROUND

Hemodynamic management after endovascular thrombectomy (EVT) for patients with acute ischemic stroke from large-vessel occlusions is a critical and unsolved challenge: four major randomized controlled trials that applied fixed systolic blood pressure targets yielded neutral or harmful results, and the 2026 American Heart Association guideline cautions against aggressive systolic blood pressure reduction below 140 mmHg in the early post-EVT period. Independent physiological data demonstrate that cerebral autoregulation is profoundly and heterogeneously impaired after LVO stroke, suggesting that population-level fixed thresholds may be intrinsically mismatched to the biological diversity of autoregulatory states across individual patients.

SUMMARY: Continuous, personalized monitoring of cerebral autoregulation offers a precise alternative to uniform blood pressure targets. Current post-EVT hemodynamic management is reactive: blood pressure is measured intermittently, population-level thresholds are applied regardless of individual physiology, and clinical deterioration is often recognized only after secondary injury has occurred. Near-infrared spectroscopy-based computation of the cerebral oximetry index enables real-time derivation of each patient's optimal mean arterial pressure and autoregulatory limits, but current monitoring platforms remain confined to specialized research settings. This review examines how recent advances in wearable ultrasound engineering, including conformal transcranial patches, wireless integrated systems, and low-cost disposable devices, create the technical foundation for portable, scalable cerebral hemodynamic monitoring with the potential to extend personalized autoregulation-guided care from specialized academic centers to community hospitals and broader stroke networks.