Abstract
The ultimate goal of therapeutic strategies for ischemic stroke is to reestablish the blood flow to the ischemic region of the brain. However, currently, the local cerebral hemodynamics (microvascular) is almost entirely inaccessible for stroke clinicians at the patient bed-side, and the recanalization of the major cerebral arteries (macrovascular) is the only available measure to evaluate the therapy, which does not always reflect the local conditions. Here we report the case of an ischemic stroke patient whose microvascular cerebral blood flow and oxygenation were monitored by a compact hybrid diffuse optical monitor during thrombolytic therapy. This monitor combined diffuse correlation spectroscopy and near-infrared spectroscopy. The reperfusion assessed by hybrid diffuse optics temporally correlated with the recanalization of the middle cerebral artery (assessed by transcranial-Doppler) and was in agreement with the patient outcome. This study suggests that upon further investigation, diffuse optics might have a potential for bed-side acute stroke monitoring and therapy guidance by providing hemodynamics information at the microvascular level.
Highlights
Intensive monitoring of physiological variables during the early hours after ischemic stroke onset reduces death, dependency, and the need for institutional care.[1]
The cerebral blood flow (CBF) was measured by diffuse correlation spectroscopy (DCS), which consisted of a modehop free long coherence length laser at 785 nm and eight avalanche photo diodes for detection as further explained in Ref. 3 and was used in prior ischemic stroke studies.[7]
We demonstrated that the home-made hybrid diffuse optical system could be utilized in the hyperacute stroke settings for real-time monitoring of the ischemic brain
Summary
Intensive monitoring of physiological variables during the early hours after ischemic stroke onset reduces death, dependency, and the need for institutional care.[1] While most interventions following ischemic stroke aim to restore the blood supply to the ischemic tissue, in practice, the local (microvascular) oxygenation, perfusion, and the metabolic status of brain is almost entirely inaccessible. The continuous brain monitoring in the framework of stroke units could potentially identify biomarkers, allowing the early detection of the tissue deterioration prior to irreversible damage and serve as a tool to individualize the clinical management.[2] currently, the real-time monitoring, even in specialized ischemic stroke units, is mostly limited to systemic physiology. The hybrid diffuse optical monitor simultaneously and transcranially followed the local cerebral blood flow (CBF) and the blood oxygenation (via the oxy- and deoxyhemoglobin concentrations) in real time and at the patient bed-side. Our method combined continuous-wave (CW) nearinfrared or diffuse optical spectroscopy (NIRS-DOS) to measure the oxy- and deoxy-hemoglobin concentrations[3] alongside diffuse correlation spectroscopy (DCS).[3,4,5] DCS is a relatively new method for direct measurement of CBF with no need for
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