In this paper we present a Time Resolved Near Infrared device for bed-side neuromonitoring of ischemic stroke patients. This system features three wavelengths allowing a better and robust retrieval of the absolute values of oxy and deoxyhaemoglobin. The device has been fully characterized following the guidelines of the MEDPHOT and BIP protocols, developed under NEUROPt project. Time Resolved spectroscopy is a promising technology that can provide reproducible results in terms of absorption and scattering coefficients. This portable and non-invasive system has been proven suitable for operation in clinical settings.
Data were collected from a cohort of 47 ischemic stroke patients and, according to their cerebral impairment, compared with normal values obtained from a group of 35 healthy subjects. Significant differences in haemoglobin species concentration and saturation were found between healthy and ischemic stroke patients. In the ischemic area of both recanalized and non-recanalized ischemic stroke patients, deoxy-haemoglobin and total haemoglobin values are higher than in controls, while tissue oxygen saturation values are lower only in recanalized patients.
In a pilot study on acute ischemic stroke (AIS) patients, unexpected periodic fluctuations in microvascular cerebral blood flow (CBF) had been observed. Motivated by the relative lack of information about the impact of the emergence of breathing disorders in association with stroke on cerebral hemodynamics, we hypothesized that these fluctuations are due to apneic and hypopneic events. A total of 28 patients were screened within the first week after stroke with a pulse oximeter. Five (18%) showed fluctuations of arterial blood oxygen saturation (≥3 % ) and were included in the study. Near-infrared diffuse correlation spectroscopy (DCS) was utilized bilaterally to measure the frontal lobe CBF alongside respiratory polygraphy. Biphasic CBF fluctuations were observed with a bilateral increase of 27.1 % ± 17.7 % and 29.0 % ± 17.4 % for the ipsilesional and contralesional hemispheres, respectively, and a decrease of −19.3 % ± 9.1 % and −21.0 % ± 8.9 % for the ipsilesional and contralesional hemispheres, respectively. The polygraph revealed that, in general, the fluctuations were associated with apneic and hypopneic events. This study motivates us to investigate whether the impact of altered respiratory patterns on cerebral hemodynamics can be detrimental in AIS patients.
Large vessel occlusion (LVO) stroke might cause different degrees of hemodynamic impairment that affects microcirculation and contributes to metabolic derangement. Time-domain near-infrared spectroscopy (TD-NIRS) estimates the oxygenation of microcirculation of cerebral outer layers. We measure hemoglobin species and tissue oxygen saturation (StO2) of anterior circulation stroke patients, classified as LVO or lacunar, and assess the differences compared with controls and according to LVO recanalization status. Fiducial markers categorize the brain region below each TD-NIRS probe as ischemic or nonstroke areas. The study includes 47 consecutive acute ischemic stroke patients and 35 controls. The ischemic area has significantly higher deoxy-hemoglobin (HbR) and total hemoglobin (HbT) compared with controls in both recanalized and nonrecanalized patients but lower StO2 only in recanalized patients. Recanalized patients have significantly lower mean StO2 in the ipsilateral hemisphere compared with nonrecanalized patients. This is the first study to report TD-NIRS measurements in acute ischemic stroke patients. TD-NIRS is able to detect significant differences in hemoglobin species in LVO stroke compared with controls and according to recanalization status. This preliminary data might suggest that StO2 can serve as a surrogate functional marker of the metabolic activity of rescued brain tissue.