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Real-Time Monitoring of Neurocritical Patients with Diffuse Optical Spectroscopies
Published on: November 19, 2020
Near-infrared spectroscopy in carotid artery stenting predicts cerebral hyperperfusion syndrome
S Matsumoto1, I Nakahara, T Higashi
1Department of Neurosurgery, Kokura Memorial Hospital, 1-1 Kifunemachi, Kokura Kita-ku, Kitakyushu 802-8555, Japan. shoji-matsumoto@384.jp
Insights
Near-infrared spectroscopy (NIRS) can predict cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS). Monitoring regional cerebral oxygen saturation (rSO2) during CAS can help identify patients at risk for this serious complication.
Area of Science:
- Neurology
- Vascular Surgery
- Medical Devices
Background:
- Cerebral hyperperfusion syndrome (CHS) is a rare but potentially fatal complication following carotid artery stenting (CAS) or endarterectomy (CEA).
- CHS occurs earlier after CAS than CEA, necessitating early detection methods.
- Near-infrared spectroscopy (NIRS) offers a noninvasive approach to monitor regional cerebral oxygen saturation (rSO2).
Purpose of the Study:
- To evaluate the utility of transcranial NIRS during CAS for predicting CHS.
- To establish a monitoring method for early detection of CHS post-CAS.
Main Methods:
- Periprocedural rSO2 was monitored using bifrontal NIRS in 64 patients undergoing CAS.
- Patients' mean carotid stenosis was 76.8%.
- CHS diagnosis was confirmed by SPECT and neurological deterioration.
Main Results:
- CHS was observed in 3.1% of cases.
- A post-reperfusion rSO2 increase >24% from baseline within 3 minutes was noted in the CHS group.
- An rSO2 increase exceeding 10.0% at 3 minutes post-reperfusion predicted CHS.
Conclusions:
- Periprocedural increases in rSO2, measured by NIRS, are excellent predictors of CHS after CAS.
- NIRS monitoring during CAS can aid in identifying patients at risk for CHS.
- This technique facilitates early detection and management of CHS.
Objective:
Cerebral hyperperfusion syndrome (CHS) following carotid artery stenting (CAS) or carotid endarterectomy (CEA) is rare but often fatal once intracranial hemorrhage has occurred. In particular, CHS occurs significantly earlier after CAS than after CEA. Thus a monitoring method for early detection of CHS is required. Near-infrared spectroscopy (NIRS) provides a noninvasive monitoring technique for assessing regional cerebral oxygen saturation (rSO2). This study evaluated the usefulness of transcranial NIRS during CAS for prediction of CHS.
Methods:
Periprocedural rSO2 was monitored in 64 cases of CAS (52 men, 12 women; 71 +/- 6.6 years). The average degree of carotid stenosis was 76.8 +/- 11.3% by North American Symptomatic Carotid Endarterectomy Trial criteria. Bifrontal rSO2 was monitored during the procedure using NIRS. Seventeen patients were symptomatic and 47 were asymptomatic. CHS was diagnosed by increased cerebral blood flow by SPECT performed on the day after treatment with deterioration of neurologic symptoms.
Results:
CHS was observed in two cases (3.1%). In the CHS group, post-reperfusion rSO2 values increased >24% from baseline until 3 minutes after reperfusion. In the non-CHS group, the normal upper limit (NUL) of the rSO2 change was set at 10.0% at 3 minutes after reperfusion. In the CHS group, rSO2 at 3 minutes after reperfusion was markedly higher than the NUL. In patients showing an rSO2 at 3 minutes after reperfusion increased by more than 10.0%, CHS following CAS could be predicted.
Conclusion:
Periprocedural increases in regional cerebral oxygen saturation measured by near- infrared spectroscopy can be an excellent predictor of cerebral hyperperfusion syndrome after carotid artery stenting.
