Transcranial Doppler (TCD) with a 2 MHz pulsed-wave diagnostic ultrasound beam can facilitate the diagnosis of cerebral arterial occlusion and can improve outcomes. First, it can be used to identify the presence and location of an obstructive intracranial thrombus confirming the vascular origin of patient neurological symptoms. Second, it provides real-time bedside monitoring of thrombolysis. And finally, it augments residual flow and speeds up thrombolysis allowing patients to recover from stroke more rapidly and completely. We aim to review the latest applications and benefits of TCD in the acute phase of ischemic stroke.