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

Abstract

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 ΔBrSO 2 in LAO was compared with controls. Results— In LAO stroke, mean interhemispheric ΔBrSO 2 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 ΔBrSO 2 in most LAO subjects (16/19). Discrimination of LAO at a −3% ΔBrSO 2 cut had 84% sensitivity and 70% specificity. Addition of the G-FAST clinical score (gaze–face–arm–speech– time) to the BrSO 2 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.