Direct observation of human microcirculation during decompressive craniectomy after stroke

Area of Science:

• Neuroscience
• Medical Imaging
• Vascular Biology

Background:

• Human brain microcirculation data is limited, primarily from experimental models.
• Investigational techniques for in-vivo human brain microcirculation are scarce.
• Understanding pathophysiology of microcirculation in ischemic stroke is crucial.

Purpose of the Study:

• To test if cortical microcirculatory alterations occur in stroke patients needing surgical decompression.
• To compare blood flow and vessel density in the brain's microcirculation between stroke patients and controls.

Main Methods:

• Prospective, observational study at a university hospital.
• Sidestream dark-field (SDF) imaging used for direct observation of cortical microcirculation.
• Compared 6 stroke patients undergoing decompressive surgery with 5 control patients.

Main Results:

• Stroke patients showed intermittent or no flow in cortical vessels, unlike controls with continuous flow.
• The proportion of perfused vessels was 63.44% in stroke patients versus nearly 100% in controls.
• Perfused vessel density was significantly lower in stroke patients (2.77/mm) than controls (6.16/mm).

Conclusions:

• Sidestream dark-field imaging effectively visualized cerebral microcirculatory alterations in the operating room.
• The study documented significant reductions in cortical microvascular blood flow and vessel density in stroke patients.
• Direct visualization confirmed microcirculatory deficits in stroke patients compared to healthy controls.