Transcranial Optical Monitoring of Cerebral Hemodynamics in Acute Stroke Patients during Mechanical Thrombectomy

Rodrigo M. Forti; Christopher G. Favilla; Jeffrey M. Cochran; Wesley B. Baker; John A. Detre; Scott E. Kasner; Michael T. Mullen; Steven R. Messé; W. Andrew Kofke; Ramani Balu; David Kung; Bryan A. Pukenas; Neda I. Sedora-Roman; Robert W. Hurst; Omar A. Choudhri; Rickson C. Mesquita; Arjun G. Yodh

doi:10.1016/j.jstrokecerebrovasdis.2019.03.019

Transcranial Optical Monitoring of Cerebral Hemodynamics in Acute Stroke Patients during Mechanical Thrombectomy

Rodrigo M. Forti^*, Christopher G. Favilla, Jeffrey M. Cochran, Wesley B. Baker, John A. Detre, Scott E. Kasner, Michael T. Mullen, Steven R. Messé, W. Andrew Kofke, Ramani Balu, David Kung, Bryan A. Pukenas, Neda I. Sedora-Roman, Robert W. Hurst, Omar A. Choudhri, Rickson C. Mesquita, Arjun G. Yodh

^*Corresponding author for this work

Computer Science

Research output: Contribution to journal › Article › peer-review

14 Citations (Scopus)

Abstract

Introduction: Mechanical thrombectomy is revolutionizing treatment of acute stroke due to large vessel occlusion (LVO). Unfortunately, use of the modified Thrombolysis in Cerebral Infarction score (mTICI) to characterize recanalization of the cerebral vasculature does not address microvascular perfusion of the distal parenchyma, nor provide more than a vascular “snapshot.” Thus, little is known about tissue-level hemodynamic consequences of LVO recanalization. Diffuse correlation spectroscopy (DCS) and diffuse optical spectroscopy (DOS) are promising methods for continuous, noninvasive, contrast-free transcranial monitoring of cerebral microvasculature. Methods: Here, we use a combined DCS/DOS system to monitor frontal lobe hemodynamic changes during endovascular treatment of 2 patients with ischemic stroke due to internal carotid artery (ICA) occlusions. Results and Discussion: The monitoring instrument identified a recanalization-induced increase in ipsilateral cerebral blood flow (CBF) with little or no concurrent change in contralateral CBF and extracerebral blood flow. The results suggest that diffuse optical monitoring is sensitive to intracerebral hemodynamics in patients with ICA occlusion and can measure microvascular responses to mechanical thrombectomy.

Original language	English
Pages (from-to)	1483-1494
Number of pages	12
Journal	Journal of Stroke and Cerebrovascular Diseases
Volume	28
Issue number	6
DOIs	https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.03.019
Publication status	Published - Jun 2019

Bibliographical note

Funding Information:
Funding: National Institutes of Health (NIH) through grants R01-NS060653 (AGY), P41-EB015893 (AGY and JAD), and 1R01NS082309-01A1 (WK, RB, WB, and AY). Sao Paulo Research Foundation (FAPESP) through grants 2013/07559-3 (RCM) and 2016/13139-5 (RMF). Funding: National Institutes of Health (NIH) through grants R01-NS060653 (AGY), P41-EB015893 (AGY and JAD), and 1R01NS082309-01A1 (WK, RB, WB, and AY). Sao Paulo Research Foundation ( FAPESP) through grants 2013/07559-3 (RCM) and 2016/13139-5 (RMF). We acknowledge the support of the National Institute of Health (NIH) through grants R01-NS060653 (AY), P41-EB015893 (AY and JD), and 1R01NS082309-01A1 (WK, RB, WB, and AY), as well as the support by the Sao Paulo Research Foundation (FAPESP) through grants 2013/07559-3 (RM) and 2016/13139-5 (RF). We would also like to acknowledge the research coordinator responsible for this project, Nichole Galatti. AY and JD are inventors on USA Patent #8082015, “Optical measurement of tissue blood flow hemodynamics and oxygenation.” Several authors (AY, JD, WK, WB, RB and RM) are also inventors on pending patent applications for associated DCS technologies. No compensation for this intellectual property has been received by any author, the University of Pennsylvania or the University of Campinas. RF and CF collected all the data and wrote the first draft of the manuscript. RF, JC, WB, RM, and AY designed the data analysis protocol, and RF conducted the final analysis. DK, NS, BP, RH, and OC performed the endovascular treatments described. All authors assisted with data interpretation, contributed to manuscript revision, read and approved the submitted version. Funding: National Institutes of Health (NIH) through grants R01-NS060653 (AGY), P41-EB015893 (AGY and JAD), and 1R01NS082309-01A1 (WK, RB, WB, and AY). Sao Paulo Research Foundation ( FAPESP) through grants 2013/07559-3 (RCM) and 2016/13139-5 (RMF).

Funding Information:
We acknowledge the support of the National Institute of Health (NIH) through grants R01-NS060653 (AY), P41-EB015893 (AY and JD), and 1R01NS082309-01A1 (WK, RB, WB, and AY), as well as the support by the Sao Paulo Research Foundation (FAPESP) through grants 2013/07559-3 (RM) and 2016/13139-5 (RF). We would also like to acknowledge the research coordinator responsible for this project, Nichole Galatti.

Publisher Copyright:
© 2019 Elsevier Inc.

Keywords

Cerebral blood flow measurement
diffuse correlation spectroscopy
ischemic stroke
mechanical thrombectomy
near-infrared spectroscopy
recanalization

ASJC Scopus subject areas

Surgery
Rehabilitation
Clinical Neurology
Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.jstrokecerebrovasdis.2019.03.019

Cite this

Forti, R. M., Favilla, C. G., Cochran, J. M., Baker, W. B., Detre, J. A., Kasner, S. E., Mullen, M. T., Messé, S. R., Kofke, W. A., Balu, R., Kung, D., Pukenas, B. A., Sedora-Roman, N. I., Hurst, R. W., Choudhri, O. A., Mesquita, R. C., & Yodh, A. G. (2019). Transcranial Optical Monitoring of Cerebral Hemodynamics in Acute Stroke Patients during Mechanical Thrombectomy. Journal of Stroke and Cerebrovascular Diseases, 28(6), 1483-1494. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.03.019

@article{e4c6b08ef1bf4c2d908dbade21bcd8e0,

title = "Transcranial Optical Monitoring of Cerebral Hemodynamics in Acute Stroke Patients during Mechanical Thrombectomy",

abstract = "Introduction: Mechanical thrombectomy is revolutionizing treatment of acute stroke due to large vessel occlusion (LVO). Unfortunately, use of the modified Thrombolysis in Cerebral Infarction score (mTICI) to characterize recanalization of the cerebral vasculature does not address microvascular perfusion of the distal parenchyma, nor provide more than a vascular “snapshot.” Thus, little is known about tissue-level hemodynamic consequences of LVO recanalization. Diffuse correlation spectroscopy (DCS) and diffuse optical spectroscopy (DOS) are promising methods for continuous, noninvasive, contrast-free transcranial monitoring of cerebral microvasculature. Methods: Here, we use a combined DCS/DOS system to monitor frontal lobe hemodynamic changes during endovascular treatment of 2 patients with ischemic stroke due to internal carotid artery (ICA) occlusions. Results and Discussion: The monitoring instrument identified a recanalization-induced increase in ipsilateral cerebral blood flow (CBF) with little or no concurrent change in contralateral CBF and extracerebral blood flow. The results suggest that diffuse optical monitoring is sensitive to intracerebral hemodynamics in patients with ICA occlusion and can measure microvascular responses to mechanical thrombectomy.",

keywords = "Cerebral blood flow measurement, diffuse correlation spectroscopy, ischemic stroke, mechanical thrombectomy, near-infrared spectroscopy, recanalization",

author = "Forti, {Rodrigo M.} and Favilla, {Christopher G.} and Cochran, {Jeffrey M.} and Baker, {Wesley B.} and Detre, {John A.} and Kasner, {Scott E.} and Mullen, {Michael T.} and Mess{\'e}, {Steven R.} and Kofke, {W. Andrew} and Ramani Balu and David Kung and Pukenas, {Bryan A.} and Sedora-Roman, {Neda I.} and Hurst, {Robert W.} and Choudhri, {Omar A.} and Mesquita, {Rickson C.} and Yodh, {Arjun G.}",

note = "Funding Information: Funding: National Institutes of Health (NIH) through grants R01-NS060653 (AGY), P41-EB015893 (AGY and JAD), and 1R01NS082309-01A1 (WK, RB, WB, and AY). Sao Paulo Research Foundation (FAPESP) through grants 2013/07559-3 (RCM) and 2016/13139-5 (RMF). Funding: National Institutes of Health (NIH) through grants R01-NS060653 (AGY), P41-EB015893 (AGY and JAD), and 1R01NS082309-01A1 (WK, RB, WB, and AY). Sao Paulo Research Foundation ( FAPESP) through grants 2013/07559-3 (RCM) and 2016/13139-5 (RMF). We acknowledge the support of the National Institute of Health (NIH) through grants R01-NS060653 (AY), P41-EB015893 (AY and JD), and 1R01NS082309-01A1 (WK, RB, WB, and AY), as well as the support by the Sao Paulo Research Foundation (FAPESP) through grants 2013/07559-3 (RM) and 2016/13139-5 (RF). We would also like to acknowledge the research coordinator responsible for this project, Nichole Galatti. AY and JD are inventors on USA Patent #8082015, “Optical measurement of tissue blood flow hemodynamics and oxygenation.” Several authors (AY, JD, WK, WB, RB and RM) are also inventors on pending patent applications for associated DCS technologies. No compensation for this intellectual property has been received by any author, the University of Pennsylvania or the University of Campinas. RF and CF collected all the data and wrote the first draft of the manuscript. RF, JC, WB, RM, and AY designed the data analysis protocol, and RF conducted the final analysis. DK, NS, BP, RH, and OC performed the endovascular treatments described. All authors assisted with data interpretation, contributed to manuscript revision, read and approved the submitted version. Funding: National Institutes of Health (NIH) through grants R01-NS060653 (AGY), P41-EB015893 (AGY and JAD), and 1R01NS082309-01A1 (WK, RB, WB, and AY). Sao Paulo Research Foundation ( FAPESP) through grants 2013/07559-3 (RCM) and 2016/13139-5 (RMF). Funding Information: We acknowledge the support of the National Institute of Health (NIH) through grants R01-NS060653 (AY), P41-EB015893 (AY and JD), and 1R01NS082309-01A1 (WK, RB, WB, and AY), as well as the support by the Sao Paulo Research Foundation (FAPESP) through grants 2013/07559-3 (RM) and 2016/13139-5 (RF). We would also like to acknowledge the research coordinator responsible for this project, Nichole Galatti. Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",

year = "2019",

month = jun,

doi = "10.1016/j.jstrokecerebrovasdis.2019.03.019",

language = "English",

volume = "28",

pages = "1483--1494",

journal = "Journal of Stroke and Cerebrovascular Diseases",

issn = "1052-3057",

publisher = "WB Saunders",

number = "6",

}

Forti, RM, Favilla, CG, Cochran, JM, Baker, WB, Detre, JA, Kasner, SE, Mullen, MT, Messé, SR, Kofke, WA, Balu, R, Kung, D, Pukenas, BA, Sedora-Roman, NI, Hurst, RW, Choudhri, OA, Mesquita, RC & Yodh, AG 2019, 'Transcranial Optical Monitoring of Cerebral Hemodynamics in Acute Stroke Patients during Mechanical Thrombectomy', Journal of Stroke and Cerebrovascular Diseases, vol. 28, no. 6, pp. 1483-1494. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.03.019

TY - JOUR

T1 - Transcranial Optical Monitoring of Cerebral Hemodynamics in Acute Stroke Patients during Mechanical Thrombectomy

AU - Forti, Rodrigo M.

AU - Favilla, Christopher G.

AU - Cochran, Jeffrey M.

AU - Baker, Wesley B.

AU - Detre, John A.

AU - Kasner, Scott E.

AU - Mullen, Michael T.

AU - Messé, Steven R.

AU - Kofke, W. Andrew

AU - Balu, Ramani

AU - Kung, David

AU - Pukenas, Bryan A.

AU - Sedora-Roman, Neda I.

AU - Hurst, Robert W.

AU - Choudhri, Omar A.

AU - Mesquita, Rickson C.

AU - Yodh, Arjun G.

N1 - Funding Information: Funding: National Institutes of Health (NIH) through grants R01-NS060653 (AGY), P41-EB015893 (AGY and JAD), and 1R01NS082309-01A1 (WK, RB, WB, and AY). Sao Paulo Research Foundation (FAPESP) through grants 2013/07559-3 (RCM) and 2016/13139-5 (RMF). Funding: National Institutes of Health (NIH) through grants R01-NS060653 (AGY), P41-EB015893 (AGY and JAD), and 1R01NS082309-01A1 (WK, RB, WB, and AY). Sao Paulo Research Foundation ( FAPESP) through grants 2013/07559-3 (RCM) and 2016/13139-5 (RMF). We acknowledge the support of the National Institute of Health (NIH) through grants R01-NS060653 (AY), P41-EB015893 (AY and JD), and 1R01NS082309-01A1 (WK, RB, WB, and AY), as well as the support by the Sao Paulo Research Foundation (FAPESP) through grants 2013/07559-3 (RM) and 2016/13139-5 (RF). We would also like to acknowledge the research coordinator responsible for this project, Nichole Galatti. AY and JD are inventors on USA Patent #8082015, “Optical measurement of tissue blood flow hemodynamics and oxygenation.” Several authors (AY, JD, WK, WB, RB and RM) are also inventors on pending patent applications for associated DCS technologies. No compensation for this intellectual property has been received by any author, the University of Pennsylvania or the University of Campinas. RF and CF collected all the data and wrote the first draft of the manuscript. RF, JC, WB, RM, and AY designed the data analysis protocol, and RF conducted the final analysis. DK, NS, BP, RH, and OC performed the endovascular treatments described. All authors assisted with data interpretation, contributed to manuscript revision, read and approved the submitted version. Funding: National Institutes of Health (NIH) through grants R01-NS060653 (AGY), P41-EB015893 (AGY and JAD), and 1R01NS082309-01A1 (WK, RB, WB, and AY). Sao Paulo Research Foundation ( FAPESP) through grants 2013/07559-3 (RCM) and 2016/13139-5 (RMF). Funding Information: We acknowledge the support of the National Institute of Health (NIH) through grants R01-NS060653 (AY), P41-EB015893 (AY and JD), and 1R01NS082309-01A1 (WK, RB, WB, and AY), as well as the support by the Sao Paulo Research Foundation (FAPESP) through grants 2013/07559-3 (RM) and 2016/13139-5 (RF). We would also like to acknowledge the research coordinator responsible for this project, Nichole Galatti. Publisher Copyright: © 2019 Elsevier Inc.

PY - 2019/6

Y1 - 2019/6

N2 - Introduction: Mechanical thrombectomy is revolutionizing treatment of acute stroke due to large vessel occlusion (LVO). Unfortunately, use of the modified Thrombolysis in Cerebral Infarction score (mTICI) to characterize recanalization of the cerebral vasculature does not address microvascular perfusion of the distal parenchyma, nor provide more than a vascular “snapshot.” Thus, little is known about tissue-level hemodynamic consequences of LVO recanalization. Diffuse correlation spectroscopy (DCS) and diffuse optical spectroscopy (DOS) are promising methods for continuous, noninvasive, contrast-free transcranial monitoring of cerebral microvasculature. Methods: Here, we use a combined DCS/DOS system to monitor frontal lobe hemodynamic changes during endovascular treatment of 2 patients with ischemic stroke due to internal carotid artery (ICA) occlusions. Results and Discussion: The monitoring instrument identified a recanalization-induced increase in ipsilateral cerebral blood flow (CBF) with little or no concurrent change in contralateral CBF and extracerebral blood flow. The results suggest that diffuse optical monitoring is sensitive to intracerebral hemodynamics in patients with ICA occlusion and can measure microvascular responses to mechanical thrombectomy.

AB - Introduction: Mechanical thrombectomy is revolutionizing treatment of acute stroke due to large vessel occlusion (LVO). Unfortunately, use of the modified Thrombolysis in Cerebral Infarction score (mTICI) to characterize recanalization of the cerebral vasculature does not address microvascular perfusion of the distal parenchyma, nor provide more than a vascular “snapshot.” Thus, little is known about tissue-level hemodynamic consequences of LVO recanalization. Diffuse correlation spectroscopy (DCS) and diffuse optical spectroscopy (DOS) are promising methods for continuous, noninvasive, contrast-free transcranial monitoring of cerebral microvasculature. Methods: Here, we use a combined DCS/DOS system to monitor frontal lobe hemodynamic changes during endovascular treatment of 2 patients with ischemic stroke due to internal carotid artery (ICA) occlusions. Results and Discussion: The monitoring instrument identified a recanalization-induced increase in ipsilateral cerebral blood flow (CBF) with little or no concurrent change in contralateral CBF and extracerebral blood flow. The results suggest that diffuse optical monitoring is sensitive to intracerebral hemodynamics in patients with ICA occlusion and can measure microvascular responses to mechanical thrombectomy.

KW - Cerebral blood flow measurement

KW - diffuse correlation spectroscopy

KW - ischemic stroke

KW - mechanical thrombectomy

KW - near-infrared spectroscopy

KW - recanalization

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ER -

Transcranial Optical Monitoring of Cerebral Hemodynamics in Acute Stroke Patients during Mechanical Thrombectomy

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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