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Background: Diffuse correlation spectroscopy (DCS) is a non-invasive optical technique that enables continuous blood flow measurements in various organs, including the brain. DCS quantitatively measures blood flow from temporal fluctuations in the intensity of diffusely reflected light caused by the dynamic scattering of light from moving red blood cells within the tissue., Methods: We performed bilateral cerebral blood flow (CBF) measurements using a custom DCS device in patients undergoing neuroendovascular interventions for acute ischemic stroke. Experimental, clinical, and imaging data were collected in a prospective manner., Results: The device was successfully applied in nine subjects. There were no safety concerns or interference with the standard angiography suite or intensive care unit workflow. Six cases were selected for final analysis and interpretation. DCS measurements with photon count rates greater than 30 KHz had sufficient signal-to-noise to resolve blood flow pulsatility. We found an association between angiographic changes in cerebral reperfusion (partial or complete reperfusion established in stroke thrombectomy cases; temporary flow arrest during carotid artery stenting) and those observed intraprocedurally with CBF measurements via DCS. Limitations of the current technology included sensitivity to the interrogated tissue volume under the probe and the effect of local changes in tissue optical properties on the accuracy of CBF estimates., Conclusion: Our initial experience with DCS in neurointerventional procedures showed the feasibility of this non-invasive approach in providing continuous measurement of regional CBF brain tissue properties., Competing Interests: Competing interests: MM: grant: NIH; consultant: Cerenovus, Medtronic; stock options: Bendit Technologies, Borvo Medical, BrainQ, Endostream, Serenity Medical, Synchron, Sim&Cure, QAS.AI, Quantanosis.AI; Assistant Editor for JNIS. WSB: grant: Athersys, BMS, Florida High Tech Corridor, NIH, Reneuron, VuEssence; consultant: Genentech, VuEssence; stock options: VuEssence; other: PRIME Education. ABP: grant: NIH; stock options: SPKL LLC., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)