Near-infrared spectroscopy cerebral oximetry as a predictor of neurological intolerance during carotid artery stenting with proximal protection

Kakumoto, Kohsuke; Harada, Kei; Sankoda, Yukihiro; Taniguchi, Syunsuke; Fukuyama, Kouzou

doi:10.1016/j.jocn.2018.09.034

Journal of Clinical Neuroscience

2018

DOI: 10.1016/j.jocn.2018.09.034

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Near-infrared spectroscopy cerebral oximetry as a predictor of neurological intolerance during carotid artery stenting with proximal protection

Kohsuke Kakumoto

Kei Harada

Yukihiro Sankoda

et al.

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“…This helps the interventional radiologist to deflate the balloon at the earliest to reestablish the cerebral blood flow. 3 We present the case of a 63-year-old male patient who presented with recurrent transient ischemic attacks in the form of slurred speech and right upper and lower limbs weakness. Informed consent was taken from the patient prior to publishing this report.…”

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Limitation of Near Infrared Spectroscopy Cerebral Oximetry in Predicting Neurologic Intolerance during Carotid Artery Stenting with Proximal Protection

Bilgi

Mishra

Radhakrishnan

et al. 2019

Journal of Neuroanaesthesiology and Critical Care

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Proximal balloon occlusion prior to carotid artery stenting is considered a relatively safe practice during endovascular treatment of carotid artery stenosis. Transient neurological deterioration affecting the ipsilateral hemisphere is seen soon after balloon inflation, when placed proximal to the stenotic segment. This occurs in cases of bilateral carotid disease due to insufficient collateral blood flow from the contralateral side. Near infrared spectroscopy cerebral oximetry (NIRS) is a valuable tool in detecting hypoperfusion- induced cerebral tissue desaturation (rSO2) during these procedures. This helps the interventional radiologist to deflate the balloon at the earliest to re-establish the cerebral blood flow. The non-invasive nature and continuous real-time interpretation make NIRS an attractive adjunct in the neuroanesthesiolgist's armamentarium for monitoring cerebral ischemia. However, significant contribution from chromophores in the extra-cerebral tissues and external carotid artery circulation can limit its sensitivity during occlusion of the internal carotid artery. In our case, it did not reflect brain ischemia during hypotension and when the neurologic symptoms were obvious. Commonly available cerebral oximetry sensors placed over the frontal region do not cover the parietal lobe where ischemia is likely to occur during occlusion of the carotid artery. In such scenarios, it has been shown that multi-channel NIRS has a better sensitivity in detecting cerebral ischemia. This case report highlights the importance of frequent neurological examination during carotid stenting as rSO2 values might not always suggest cerebral ischemia.

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confidence: 99%

Limitation of Near Infrared Spectroscopy Cerebral Oximetry in Predicting Neurologic Intolerance during Carotid Artery Stenting with Proximal Protection

Bilgi

Mishra

Radhakrishnan

et al. 2019

Journal of Neuroanaesthesiology and Critical Care

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Diagnostic and prognostic values of cerebral oxygen saturations measured by INVOS™ in patients with ischemic and hemorrhagic cerebrovascular disease

Eroğlu

Aksel

Yönak

et al. 2019

Turkish Journal of Emergency Medicine

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Objectives In this study it was aimed to investigate whether measurement of potential changes of cerebral oxygenation saturations due to ischemic or hemorrhagic cerebrovascular diseases have an early diagnostic and prognostic value. Methods Adult patients (≥18 years old) having acute ischemic or hemorrhagic stroke were included in the study. Patients under 18-year-old, those with incomplete data or suspicious diagnosis were excluded. The cerebral oxygen saturations of the patients were compared with the healthy subjects. Patients were also grouped according to their clinical outcomes; good clinical status (group 1) and poor clinical status (group 2). These groups were compared according to the patients’ cerebral oxygen saturations. Results The mean oxygen saturation of the patients and healthy people were similar (59.48% ± 10.6 versus 58.44% ± 9.6). There was no difference between patients and healthy population according to cerebral oxygen saturations. Furthermore, mean oxygen levels were also similar between the hemisphere without lesion and with lesion in the patients group (59.8% ± 11.8 versus 59.2% ± 10.4). When the patients were grouped according to their clinical status, there were 30 patients in group 1 and 15 in group 2. The cerebral oxygen saturations of the hemisphere with lesion were similar between these groups and no statistical difference was observed (59.2% ± 9.3 versus 59.1% ± 12.6, p = 0.9). There was also no statistical difference between the groups when delta oxygen levels of the affected and unaffected hemispheres of the groups were calculated (0.9% ± 6.1 versus 0.13% ± 8.4, p = 0.7). Conclusion Results of this study revealed that there was no difference in cerebral oxygen saturations measured by near-infrared cerebral oximetry system between the patients with cerebrovascular disease and healthy population. Furthermore, our results did not support that the cerebral oxygen saturations may be used for determining the prognosis of the patients with cerebrovascular disease.

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Analysis of postprocedural microembolic infarctions and global oxygen extraction fraction during balloon-protected carotid artery stenting: Preliminary study

Ito

Uchida

Takasuna

et al. 2021

Surgical Neurology International

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Background: Atherosclerotic carotid stenosis with impaired cerebral perfusion is a risk factor for cerebral ischemia. In major carotid stenoocclusive diseases, increased oxygen extraction fraction (OEF) is associated with ischemic stroke. Balloon-protected carotid artery stenting (CAS) is valuable for high-grade carotid stenosis. However, while balloon-protected CAS can effectively reduce the occurrence of ischemic complications by blocking carotid flow, cerebral hypoperfusion may result in simultaneous cerebral ischemia. We sought to evaluate whether increased OEF during balloon-protected CAS can predict postprocedural microembolic infarction (MI). Methods: Eighty-four patients who underwent balloon-protected CAS were enrolled. Initial, intraprocedural, and postprocedural OEFs were calculated from the cerebral arteriovenous oxygen differences obtained from blood sampled just before the temporary occlusion and reperfusion of the internal carotid artery during and after the procedure. MIs were evaluated by diffusion-weighted imaging (DWI). Patients were classified into two groups based on the presence or absence of new MIs, and the relationship between the OEF and postprocedural MIs was analyzed. Results: New DWI-positive lesions were found in 37 cases (44.0%). Age, signal intensity ratio (SIR) of carotid plaque on T1-weighted black blood magnetic resonance imaging, and intraprocedural OEF were significantly higher in the DWI-positive group. The high SIR and intraprocedural OEF were significantly associated with the development of postprocedural MIs in multivariate analysis. MIs were correlated with the increase in OEF. Conclusion: Increased intraprocedural OEF, obtained by blood sampling during balloon-protected CAS, could predict the incidence of postprocedural MIs. Patients with carotid stenosis could be hemodynamically compromised by carotid flow blockage during balloon-protected CAS.

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Near-infrared spectroscopy cerebral oximetry as a predictor of neurological intolerance during carotid artery stenting with proximal protection

Cited by 3 publications

References 12 publications

Limitation of Near Infrared Spectroscopy Cerebral Oximetry in Predicting Neurologic Intolerance during Carotid Artery Stenting with Proximal Protection

Limitation of Near Infrared Spectroscopy Cerebral Oximetry in Predicting Neurologic Intolerance during Carotid Artery Stenting with Proximal Protection

Diagnostic and prognostic values of cerebral oxygen saturations measured by INVOS™ in patients with ischemic and hemorrhagic cerebrovascular disease

Analysis of postprocedural microembolic infarctions and global oxygen extraction fraction during balloon-protected carotid artery stenting: Preliminary study

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