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

Sabine L Collette; Allart M Venema; Nick Eleveld; Anthony R Absalom; Thomas Wl Scheeren; Simon Verhoeve; Jan Cees de Groot; Jan Willem J Elting; Maarten Uyttenboogaart; Reinoud Ph Bokkers; Marko M Sahinovic

doi:10.1177/23969873221107824

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

Eur Stroke J. 2022 Dec;7(4):384-392. doi: 10.1177/23969873221107824. Epub 2022 Jul 10.

Affiliations

¹ Department of Radiology, Medical Imaging Centre, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
² Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.

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.

Keywords: Anaesthesia; endovascular procedures; ischaemic stroke; near-infrared; prospective studies; spectroscopy.