Novel Use of Intracranial Arterial Pressure Waveforms to Detect Occlusive Events During Neuroendovascular Treatment

Unexpected occlusive events, such as thrombosis, can cause serious complications during neuroendovascular treatment. Angiography provides only intermittent assessments, potentially missing rapidly developing occlusions, highlighting the need for continuous monitoring. This retrospective study assessed how accurately continuous monitoring of intracranial arterial pressure waveforms can detect occlusive events.

We computed wavelet-based time-frequency amplitude of intracranial arterial pressure waveforms at frequencies ranging from 6 to 18 Hz in each of the 6444 trials obtained from 43 arteries in 37 patients. We determined whether modulation of this amplitude correctly classified the patent or occluded states defined by angiography.

Mixed-model analysis revealed a significant increase in time-frequency amplitude during occlusive events (P < 0.001). Receiver operating characteristic analysis indicated that an increase of ≥13.9% from baseline in the 6-18 Hz time-frequency amplitude could detect occlusive events with a sensitivity of 88.5%, specificity of 87.5%, positive predictive value of 36.1%, and negative predictive value of 96.4%. A sustained increase of ≥14.3% for 5 or more consecutive trials could detect occlusive events with a sensitivity of 82.3%, specificity of 96.8%, positive predictive value of 75.5%, and negative predictive value of 94.8%.

Our preliminary study suggests that continuous intracranial arterial pressure monitoring holds promise as an adjunctive tool to accurately detect occlusive events. A prospective study is warranted to definitively establish its diagnostic value during neuroendovascular treatment.