Abstract Details

Title Investigating the Relationship Between Oximetry Trends During Endovascular Therapy and Neurological Worsening for Patients with Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S24 - Cerebrovascular Disease and Interventional Neurology: Endovascular Thrombectomy and Large Vessel Occlusions (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

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.

Objective

Categorize near-infrared spectroscopy (NIRS) trends into descriptive “fingerprints” and examine the relationship between these fingerprints and neurological worsening.

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.

Authors/Disclosures
Madelynne Olexa PRESENTER	Miss Olexa has nothing to disclose.
Yelyzaveta Begunova	Miss Begunova has nothing to disclose.
David Bartolome (Yale University School of Medicine)	Mr. Bartolome has nothing to disclose.
Teng J. Peng, MD (University of Florida)	Dr. Peng has nothing to disclose.
Charles Matouk	No disclosure on file
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Nils Petersen, MD (Yale University)	Dr. Petersen has received research support from NIH.