Near-infrared spectroscopy monitoring during endovascular treatment for acute ischaemic stroke

Abstract

Introduction: The aim of endovascular treatment (EVT) for acute ischaemic stroke is to relieve the cerebral tissue hypoxia in the area supplied by the occluded artery. Near-infrared spectroscopy (NIRS) monitoring is developed to assess regional cerebral tissue oxygen haemoglobin saturation (rSO2). We aimed to investigate whether NIRS can detect inter- and intra-hemispheric rSO2 differences during EVT. Patients and methods: In this prospective, observational study, patients undergoing EVT for a proximal intracranial occlusion of the anterior circulation between May 2019 and November 2020, were included. A four-wavelength NIRS monitor (O3® Regional Oximeter (Masimo, Irvine, CA)) was used to measure rSO2 during EVT with sensors placed over the temporal lobes in 20 patients and over the frontal lobes in 13 patients. The Wilcoxon signed-rank test was used to test for inter-hemispheric rSO2 differences after groin puncture and after recanalisation, and intra-hemispheric rSO2 changes before and after recanalisation. Results: In the temporal cohort, no inter-hemispheric rSO2 differences were observed after groin puncture (median [IQR] rSO2 affected hemisphere, 70% [67–73] and unaffected hemisphere, 70% [66–72]; p = 0.79) and after recanalisation. There were no intra-hemispheric rSO2 changes over time. In the frontal cohort, no inter- and intra-hemispheric rSO2 differences or changes were found. Discussion and conclusion: A NIRS monitor could not detect inter- and intra-hemispheric rSO2 differences or changes during EVT, irrespective of the sensor position. It is likely that even with temporal sensor application, a significant proportion of the received NIRS signal was influenced by oxygenation of surrounding tissues.

Multimodal and autoregulation monitoring in the neurointensive care unit

“…This technique provides estimates of total hemoglobin concentration (HbT) as well as the ratio of HbO to HbT called regional cerebral oxygen saturation (rSO 2 ) or Tissue Oxygenation Index (TOI) depending on the manufacturer (185,188). Similar to PbtO 2 , rSO 2 , and TOI reflect the balance between oxygen supply and demand within the distal arterial, venous and capillary territory and has demonstrated good correlation with invasively obtained absolute CBF values in critically ill patients (189)(190)(191). The majority of NIRS applications involve placing optodes over the forehead and measure signal over the frontal lobe gray matter and watershed zone of the anterior and middle cerebral arteries with the normal range of rSO 2 being 55-80% (192,193).…”

Pre-Hospital Stroke Care beyond the MSU

“…For the detection of ischemic stroke evidence is currently inconsistent. While Kwon et al could observe an association of lower hemoglobin oxygenation within the hypoperfused hemisphere (as assessed via CT-Perfusion) [67], Collette et al could not observe changes of hemoglobin oxygenation in patients with LVO undergoing thrombectomy [68]. Limitations of the technology currently include the fact that only hematoma > 3,5cm in a superficial localization (max.…”

The importance of monitoring cerebral oxygenation in non brain injured patients

“…A number of clinical indications have been suggested for the use of different non invasive neuromonitoring tools. Among these, severe respiratory failure with or without extracorporeal membrane oxygenation (ECMO) [3,4], trauma, cardiac arrest, liver failure, intra-arterial thrombolysis during endovascular treatment [5,6], and sepsis are among the conditions where despite the absence of a primary cerebral damage, neurological complications are common and can affect patients' outcome [1]. The benefits of non invasive methods include safety, availability, and the provision of repeatable continuous data at the bedside, therefore helping clinicians detecting deterioration in neurologic function and earlier intervention [7].…”