Detection of Anterior Circulation Large Artery Occlusion in Ischemic Stroke Using Noninvasive Cerebral Oximetry

Background and Purpose— Large artery occlusion (LAO) in ischemic stroke requires recognition and triage to an endovascular stroke treatment center. Noninvasive LAO detection is needed to improve triage. Methods— Prospective study to test whether noninvasive cerebral oximetry can detect anterior circulation LAO in acute stroke. Interhemispheric &Dgr;BrSO2 in LAO was compared with controls. Results— In LAO stroke, mean interhemispheric &Dgr;BrSO2 was −8.3±5.8% (n=19), compared with 0.4±5.8% in small artery stroke (n=17), 0.4±6.0% in hemorrhagic stroke (n=14), and 0.2±7.5% in subjects without stroke (n=19) (P<0.001). Endovascular stroke treatment reduced the &Dgr;BrSO2 in most LAO subjects (16/19). Discrimination of LAO at a −3% &Dgr;BrSO2 cut had 84% sensitivity and 70% specificity. Addition of the G-FAST clinical score (gaze–face–arm–speech– time) to the BrSO2 measure had 84% sensitivity and 90% specificity. Conclusions— Noninvasive cerebral oximetry may help detect LAO in ischemic stroke, particularly when combined with a simple clinical scoring system.

[1]  A. van der Lugt,et al.  Occurrence of intracranial large vessel occlusion in consecutive, non-referred patients with acute ischemic stroke , 2016 .

[2]  H. Edmonds,et al.  Cerebral Oximetry for Cardiac and Vascular Surgery , 2004, Seminars in cardiothoracic and vascular anesthesia.

[3]  Christopher S. Coffey,et al.  Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment , 2015 .

[4]  Charith N. Cooray,et al.  Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion: Results From SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry) , 2017, Stroke.

[5]  A. Demchuk,et al.  Time to TreatmentWith Endovascular Thrombectomy andOutcomes From Ischemic Stroke : AMeta-analysis , 2016 .

[6]  B Rubinsky,et al.  The detection of brain ischaemia in rats by inductive phase shift spectroscopy , 2009, Physiological measurement.

[7]  A. Demchuk,et al.  Endovascular Therapy in Acute Ischemic Stroke: Challenges and Transition From Trials to Bedside. , 2016, Stroke.

[8]  B. Campbell,et al.  Large Vessel Occlusion Scales Increase Delivery to Endovascular Centers Without Excessive Harm From Misclassifications , 2017, Stroke.

[9]  L. Wilkins.  Correction to: Clinical Selection Strategies to Identify Ischemic Stroke Patients With Large Anterior Vessel Occlusion: Results From SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry). , 2017, Stroke.

[10]  Christopher S Coffey,et al.  2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association , 2015, Stroke.

[11]  Adnan H Siddiqui,et al.  Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. , 2016, JAMA.