Effectiveness of Near-Infrared Spectroscopy (NIRO-200NX, Pulse Mode) for Risk Management in Carotid Artery Stenting

Terakado, Toshitsugu; Marushima, Aiki; Koyama, Yoshinori; Tsuruta, Wataro; Takigawa, Tomohiro; Ito, Yoshiro; Hino, Tenyu; Sato, Masayuki; Hayakawa, Masayuki; Ishikawa, Eiichi; Inoue, Yoshiaki; Matsumaru, Yuji; Matsumura, Akira

doi:10.1016/j.wneu.2019.07.184

Cited by 14 publications

(7 citation statements)

References 23 publications

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“…NIRS can be used easily and continuously to evaluate the approximate CBF condition from regional oxygen saturation (rSO 2 ), and there are several reports on the prediction of hyperperfusion after CEA or CAS during the procedure. [15][16][17] By performing continuous NIRS monitoring after surgery, as in the present case, not only the diagnosis of HPS but also the termination of the hyperperfusion can be accurately detected, which is effective for strict management. Particularly, in the elderly, adverse events due to long-term sedation are concerning; therefore, NIRS monitoring would be a good parameter to complete the treatment.…”

Section: Only a Few Case Reports Have Documented The Incidence Of Hps After Endovascular Treatment Including Intracranialmentioning

confidence: 66%

Utility of Near-infrared Spectroscopy Monitoring in the Management of Hyperperfusion Syndrome after Intracranial Carotid Artery Stenting

Togashi

Shimizu

Suda³

2020

NMC Case Report Journal

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Cerebral hyperperfusion syndrome (HPS) is a rare complication of carotid endarterectomy (CEA) and stenting. There are only a few case reports about HPS after intracranial stenting, and its clinical course remains unclear. We report an unusual case of HPS after intracranial internal carotid artery (ICA) stenting. An 87-year-old woman underwent uneventful balloon angioplasty for the right intracranial ICA one year ago; then she presented with restenosis at the same arterial location. She then underwent an ICA stent placement procedure. Preoperative cerebral blood flow (CBF) studies revealed hemodynamic ischemia. At the time of surgery, the stenotic lesion was near-occlusion. Twelve hours after the successful stenting procedure, the patient became restless, and near-infrared spectroscopy (NIRS) indicated a blood flow increase to the affected side. Arterial spin labeling (ASL) imaging performed on the same day showed high signal intensity only in the right hemisphere. She was treated with sedation, blood pressure control, and minocycline hydrochloride administration. Because of the strict management under continuous monitoring with NIRS, her symptoms gradually improved over the next 6 days. The right-to-left difference observed with ASL imaging resolved 6 days after surgery, and she was discharged with no neurological deficit. This case highlights the utility of NIRS monitoring in the management of HPS after intracranial stenting.

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Section: Only a Few Case Reports Have Documented The Incidence Of Hps After Endovascular Treatment Including Intracranialmentioning

confidence: 66%

Utility of Near-infrared Spectroscopy Monitoring in the Management of Hyperperfusion Syndrome after Intracranial Carotid Artery Stenting

Togashi

Shimizu

Suda³

2020

NMC Case Report Journal

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“… 14 Further evidence can be derived from the balloon protection method in carotid artery stenting, where the cutoff TOI in detecting ischemic intolerance was 50% or an 80% TOI change rate as well. 15 Although one can assume that our fast- and slow-initiation CPB protocols were both safe methods for patients when looking at the grouped numerical results, it is obvious that with the higher rate of critical values (21% vs. 6%) in the fast group, one might think differently when considering individual patient safety. Even though it is still not known if fast initiation of the CBP negatively influences clinical outcomes in patients with impaired cerebral blood supply (anemia, carotid stenosis, etc.…”

Section: Discussionmentioning

confidence: 99%

Kinetics of tissue oxygenation index during fast and slow cardiopulmonary bypass initiation

Turra

Bauer²,

Möbius

et al. 2022

Perfusion

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Introduction Despite being a daily clinical application in cardiac operating theaters, an evidence-based approach on how to optimally initiate the heart–lung machine (HLM) to prevent critical phases of cerebral ischemia is still lacking. We therefore designed a study comparing two different initiation times for starting the cardiopulmonary bypass (CPB). Methods We conducted a monocentric, randomized, and prospective study comparing the impact of two initiation times, a rapid initiation of 15 s and a slow initiation of 180 s to reach the full target flow rate of 2.5 L/min/m2 times the body surface area, on cerebral tissue oxygenation by near infrared spectroscopy measurements. Results The absolute values in tissue oxygenation index (TOI) showed no difference between the groups before and after the CPB with a 10% drop in oxygenation index in both groups due to the hemodilution through the HLM priming. Looking at the kinetics a rapid initiation of CPB produced a higher negative rate of change in TOI with a total of 21% in critical oxygenation readings compared to 6% in the slow initiation group. Conclusion In order to avoid critical phases of cerebral ischemia during the initiation of CPB for cardiac procedures, we propose an initiation time of at least 90 s to reach the 100% of target flow rate of the HLM.

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“…This finding may imply that no deterioration of the right cerebral blood flow due to the improvement in right cerebral circulation after CAS may have occurred even under the ultrafiltration. Regarding the usefulness of cerebral oxygenation monitoring using NIRS in patients with carotid artery stenosis, changes in cerebral rSO 2 were reportedly beneficial to detect ischemic intolerance during CAS [14] and predict the cerebral hyperperfusion syndrome after CAS [ 14 , 15 ]. Based on the present case, intradialytic cerebral oxygenation monitoring might disclose intradialytic changes in the cerebral blood flow distribution between the ipsilateral and contralateral side in HD patients with carotid artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Near-Infrared Spectroscopy (NIRO-200NX, Pulse Mode) for Risk Management in Carotid Artery Stenting

Cited by 14 publications

References 23 publications

Utility of Near-infrared Spectroscopy Monitoring in the Management of Hyperperfusion Syndrome after Intracranial Carotid Artery Stenting

Utility of Near-infrared Spectroscopy Monitoring in the Management of Hyperperfusion Syndrome after Intracranial Carotid Artery Stenting

Kinetics of tissue oxygenation index during fast and slow cardiopulmonary bypass initiation

Changes in cerebral oxygenation during hemodialysis before and after carotid artery stenting

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