Investigating the Relationship Between Oximetry Trends During Endovascular Therapy and Neurological Worsening for Patients with Acute Ischemic Stroke
Madelynne Olexa1, Yelyzaveta Begunova1, David Bartolome2, Teng Peng3, Charles Matouk1, Kevin Sheth4, Nils Petersen5
1Yale School of Medicine, 2Yale University School of Medicine, 3Yale New Haven Hospital, 4Yale UniversityDivision of Neuro and Critical Care, 5Yale University
Objective:
Categorize near-infrared spectroscopy (NIRS) trends into descriptive “fingerprints” and examine the relationship between these fingerprints and neurological worsening.
Background:
Cerebral near-infrared spectroscopy (NIRS) is a useful tool to monitor cerebral oxygenation levels in real-time. However, the mechanisms through which varying oxygenation levels during endovascular thrombectomy (EVT) affect functional outcome remain to be determined.
Design/Methods:
We enrolled patients that presented to Yale New Haven Hospital with large vessel occlusion acute ischemic stroke and underwent EVT. NIRS was implemented into the standard operating procedure. Time stamps of defined events (medication administration, recanalization, etc.) were synchronized with corresponding NIRS values. We inspected NIRS curves from arrival in angio-suite to the time of recanalization. Neurological deterioration was defined as an increase of 4 points or more on the National Institutes of Health Stroke Scale (NIHSS).
Results:
Forty-eight patients (mean age 72 ± 13, mean NIHSS 14) were analyzed. Five “fingerprints” were observed in the affected hemisphere: sustained decreases, downward rSO2 peaks, no change, upward rSO2 peaks, and sustained increases, which were assigned nominal values of -2, -1, 0, 1, and 2, respectively. After adjusting for age and admission NIHSS, sustained decreases and downward rSO2 peaks were independently associated with neurological deterioration (P = 0.0076).
Conclusions:
Identifiable NIRS “fingerprints” of downward isolated rSO2 peaks and sustained decreases in the affected hemisphere during EVT are associated with neurological deterioration. Further distillation of identifiable intraprocedural NIRS trends in real time could provide guidance for anesthesia and hemodynamic management during EVT to optimize patient outcomes after stroke.