Continuous Time-Domain Near-Infrared Spectroscopy During Endovascular Thrombectomy Enables Early Prediction of Post-Recanalization Cortical Infarct
Rafi, M.; Khachatryan, T.; Abdel-Hadi, S.; Hason, S.; Huynh, A.; Ranasinghesagara, J.; Rivera, R.; Khachatryan, E.; Zhang, A.; Dara, S.; Xu, J.; Golshani, K.; Hsu, F. P.; Suzuki, S.; Yuki, I.; Chen, J.; Khan, I.; Stern-Nezer, S.; Chen, P.; Yoshimoto, K.; Wada, H.; Ohmae, E.; Ueda, Y.; Yu, W.; Venugopalan, V.; Akbari, Y.
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BackgroundExisting neuromonitoring tools lack the capability for continuous, intraoperative assessment of cerebral oxygenation and tissue viability during endovascular thrombectomy (EVT) of large vessel occlusion stroke. Time-domain near-infrared spectroscopy (TD-NIRS), an advanced non-invasive optical technique, may overcome this challenge. However, no study has yet investigated TD-NIRS feasibility as an intraoperative neuromonitoring tool during EVT and its capability in predicting post-recanalization infarct. MethodsIn this prospective observational study, eleven patients with middle cerebral artery or internal carotid artery occlusion were monitored during EVT using TD-NIRS. Absolute concentrations of oxyhemoglobin ([HbO2]), deoxyhemoglobin ([HHb]), total hemoglobin ([tHb]), and tissue oxygen saturation (StO2) on both hemispheres was derived using a scaled Monte Carlo approach. Patients were dichotomized into post-EVT cortical infarct and no infarct, and the {Delta}[HbO2]/[HHb] pre- vs post-recanalization was assessed. ResultsSignificant differences were observed in pre- vs post-recanalization [HbO2] (p=0.0068), [HHb] (p=0.042), and StO2 (p=0.0020) on the affected hemisphere. The {Delta}[HbO2]/[HHb] significantly differed between patients with and without post-EVT infarct (p=0.0043). Logistic regression (p=0.0041) and ROC (AUC=0.82) determined that {Delta}[HbO2]/[HHb] reliably predicts post-EVT cortical infarct. ConclusionsThese results suggest TD-NIRS as a novel, adjunctive intraoperative neuromonitoring tool during EVT, with potential to predict post-EVT cortical infarct, guiding clinical management before/after thrombectomy. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=110 SRC="FIGDIR/small/26345790v1_ufig1.gif" ALT="Figure 1"> View larger version (55K): org.highwire.dtl.DTLVardef@106e02eorg.highwire.dtl.DTLVardef@681070org.highwire.dtl.DTLVardef@f3387org.highwire.dtl.DTLVardef@2df_HPS_FORMAT_FIGEXP M_FIG C_FIG
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