Why are so many strokes in young patients missed? Dr. Thomas Devlin, nationally recognized stroke neurologist and executive medical director at CHI Memorial, explains how robotic transcranial Doppler (TCD) is reshaping stroke and PFO pathways.

We cover why TCD is more sensitive than traditional echo, what the Bubble Trial revealed, and how robotic automation is changing workflows in neurology and cardiology.

Episode Breakdown

00:00 – Opening and the challenge of detecting PFO with echo

01:11 – Introducing Dr. Thomas Devlin and the Bubble Trial

03:01 – Why strokes in young patients often go unexplained

05:25 – EEG vs robotic TCD: sensitivity and workflow

07:09 – Why PFO must always stay on the differential

10:13 – Meta-analyses and limitations of echo sensitivity

12:29 – Advantages of robotic TCD and real-world performance

15:46 – Benefits for techs and labs: automation and ease of use

16:06 – The Bubble Trial: robotic TCD detects 3x more large shunts

18:02 – Case study: negative echo, positive robotic TCD, large PFO

19:41 – Editorial response and the call for independent validation

20:16 – The Bubble-QE study: real-world validation and outcomes

22:53 – Multicenter results: robotic TCD vs echo and TEE

24:11 – Integrating robotic TCD into national cryptogenic stroke protocols

26:50 – How the Pascal score guides closure decisions

30:00 – Economics: reimbursement and hospital adoption

33:05 – Building trust between neurologists and cardiologists

35:00 – Guidelines and national rollout of robotic TCD

37:05 – Comparing manual vs robotic: why automation wins

42:54 – Structure, incentives, and improving stroke workups

46:47 – Who “owns” the neurovascular lab: neurology vs cardiology

50:16 – Reimbursement and payer considerations 55:38 – Lessons from emerging economies and value-based innovation

58:13 – Future use cases: ambulance, helicopter, and OR monitoring

1:03:34 – Final thoughts and why this is the third chapter of stroke innovation

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