A Novel Use of Intracranial Arterial Pressure Waveforms to Detect Occlusive events

During neuroendovascular treatment, unexpected occlusive events, such as thrombosis, may occur and can cause severe complications. However, angiography provides only intermittent assessments of intravascular conditions, underscoring the need for continuous monitoring. In this retrospective study, we examined whether intracranial arterial pressure waveforms recorded via a catheter could detect occlusive events. A total of 6,442 waveform trials from 43 arteries in 37 patients, each assessed in both patent and occluded states, were analyzed. Time-frequency amplitude (TFA) was calculated via wavelet transformation in selected frequency ranges (6 to 10, 10 to 14, 14 to 18, and 6 to 18 Hz). A mixed-model analysis revealed that TFA was significantly higher under occluded conditions (p < 0.001). Specifically, when focusing on the 6 to 18 Hz range and using a 113.9% elevation in TFA from the initial patent baseline as a threshold, the average sensitivity, specificity, positive predictive value, and negative predictive value for detecting occlusion were 88.5%, 87.5%, 36.1%, and 96.4%, respectively. These findings suggest that continuous waveform analysis may serve as a valuable complement to intermittent angiographic assessments, potentially enhancing both safety and therapeutic outcomes in neuroendovascular procedures.