Evaluating a Novel EEG-Based Index for Stroke Detection Under Anesthesia During Mechanical Thrombectomy.

Area of Science:

• Neuroscience
• Medical Technology
• Anesthesiology

Background:

• Rapid identification of acute stroke (AS) during anesthesia is crucial for timely intervention and improved patient outcomes.
• Investigating novel biomarkers for intraoperative stroke detection is essential for enhancing patient safety.
• The lateral interconnection ratio (LIR), an electroencephalogram (EEG)-based marker, was explored for its potential in identifying AS during endovascular thrombectomy (EVT).

Purpose of the Study:

• To evaluate the efficacy of the novel 2-channel EEG-based lateral interconnection ratio (LIR) for detecting acute stroke (AS) in patients undergoing endovascular thrombectomy (EVT) under general anesthesia (GA) or sedation.
• To compare LIR values between AS patients and reference groups without neurological complications.
• To assess the relationship between LIR, stroke dynamics, stroke location, and anesthesia type.

Main Methods:

• One hundred patients undergoing EVT for AS were monitored using EEG during and for 4 hours post-procedure.
• The National Institutes of Health Stroke Scale (NIHSS) was used to assess neurological status before and after EVT.
• LIR was compared between AS patients and two reference groups, and its correlation with clinical outcomes, stroke site, and anesthesia type was analyzed.

Main Results:

• Patients with AS exhibited significantly lower LIR values compared to reference groups (P <0.000002).
• LIR demonstrated a significant increase in AS patients who showed clinical recovery post-EVT compared to those who did not (P <0.007).
• The LIR appeared more sensitive to anterior circulation strokes and was not influenced by the type of anesthesia (GA vs. sedation).

Conclusions:

• The study validates the utility of acute stroke (AS) patients undergoing endovascular thrombectomy (EVT) as a model for assessing novel EEG markers like LIR.
• The lateral interconnection ratio (LIR) shows potential as a sensitive indicator for intraoperative stroke detection.
• Further large-scale validation studies involving diverse surgical procedures and anesthesia types are warranted to confirm the LIR's clinical applicability.