Propagating Relationship of Cerebral Oximetric Volume and the Clinical Outcome of Recombinant Tissue Plasminogen Activator (r-TPA) Therapy on Acute Cerebral Ischemic Stroke Patients

  • Sepideh Paybast ORCID Neurology Department, Bouali Sina Hospital, Qazvin University of medical sciences and health, Qazvin, Iran
  • Ali Ashraf ORCID Mail Clinical Research Development Unit, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
  • Hakimeh Sarshad ORCID Clinical Research Development Unit, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
  • Maryam Shakiba ORCID Department of Health Education and Services, School of Health, Guilan University of Medical Sciences, Rasht, Iran
  • Yaser Moadabi ORCID Department of Neurology, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
Spectroscopy, Near-Infrared, Stroke, Oximetry, Tissue Plasminogen Activator, Outcome


Introduction: Currently, the most available treatment for acute ischemic stroke (AIS) is thrombolytic therapy with recombinant tissue plasminogen activator (r-TPA). A challenge in r-TPA therapy is the prediction of recovery in each case. Objective: The aim was to find a possible relationship between the cerebral oximetry indexes and the clinical outcome of r-TPA therapy to assess the cerebral oximetry as a non-invasive monitoring agent for therapy. Methods: The inclusion criteria were all patients with AIS who received r-TPA. The neurologic status was evaluated based on the national institutes of health stroke scale (NIHSS) score at arrival, and after a period of 24 hours. In addition, the levels of brain oxygenation in both hemispheres were measured before and continuously over the first 24 hours after r-TPA injection, using an oximetric sensor in the frontal lobes. The clinical success was defined as a 4-point improvement from the baseline NIHSS. Results: Total 44 patients with the mean age of 58.2 ± 2.18 years were enrolled, of whom 68.18% were male. Twenty-eight patients remained clinically unimproved and 16 patients were improved. A significant difference was found in the mean surface area under the brain oximetric curve in the 24 hour, in the affected hemisphere in the improved group, compared to the unimproved group (P = 0.007). There was a significant difference between the mean increase in brain oxygenation within 24 hours in the improved and unimproved groups (P = 0.002). Conclusion: The cerebral oximetry could contribute to predict the likelihood of r-TPA prognosis in patients with AIS.


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1. Menken M, Munsat TL, Toole JF. The global burden of disease study: implications for neurology. Arch Neurol. 2000;57(3):418-20.
2. Wein T, Lindsay MP, Côté R, Foley N, Berlingieri J, Bhogal S, et al. Canadian stroke best practice recommendations: Secondary prevention of stroke, practice guidelines, update 2017. Int J Stroke. 2018;13(4):420-43.
3. Powers W, Rabinstein A, Ackerson T, Adeoye O, Bambakidis N, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke. Stroke. 2018;49(3):e46-110.
4. Baratloo A, Forouzanfar MM, Hashemi B, Safari S, Kasmaei HD, Rouhipour A, et al. Tissue plasminogen activator: A literature review. Arch Neurosci. 2016;3(1):e30452.
5. Boudreau DM, Guzauskas GF, Chen E, Lalla D, Tayama D, Fagan SC, et al. Cost-effectiveness of recombinant tissue-type plasminogen activator within 3 hours of acute ischemic stroke: current evidence. Stroke. 2014;45(10):3032-9.
6. De Keyser J, Gdovinová Z, Uyttenboogaart M, Vroomen PC, Luijckx GJ. Intravenous alteplase for stroke: beyond the guidelines and in particular clinical situations. Stroke. 2007;38(9):2612-8.
7. Patel RA, White C. Acute ischemic stroke treatment: State of the art. Vasc Med. 2011;16(1):19-28.
8. Bernheisel CR, Schlaudecker JD, Leopold K. Subacute management of ischemic stroke. Am Fam Physician. 2011 Dec 15;84(12):1383-8.
9. Saver JL, Goyal M, Bonafe A, Diener H-C, Levy EI, Pereira VM, et al. Solitaire™ with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial: protocol for a randomized, controlled, multicenter study comparing the Solitaire revascularization device with IV tPA with IV tPA alone in acute ischemic stroke. Int J Stroke. 2015 Apr;10(3):439-48.
10. Schellinger PD, Jansen O, Fiebach JB, Heiland S, Steiner T, Schwab S, et al. Monitoring intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke with diffusion and perfusion MRI. Stroke. 2000;31(6):1318-28.
11. Cheng NT, Kim AS. Intravenous thrombolysis for acute ischemic stroke within 3 hours versus between 3 and 4.5 hours of symptom onset. Neurohospitalist. 2015;5(3):101-9.
12. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N. Endovascular therapy for ischemic stroke with perfusion imaging selection. N Engl J Med. 2015;372(11):1009-18
13. van Seeters T, Biessels GJ, Kappelle LJ, van der Schaaf IC, Dankbaar JW, Horsch AD, et al. The prognostic value of CT angiography and Ct perfusion in acute ischemic stroke. Cerebrovasc Dis. 2015;40(5-6):258-69.
14. Kim JS. Stroke in A sia: a global disaster. Int J Stroke. 2014;9(7):856-7.
15. Donkel SJ, Benaddi B, Dippel DW, ten Cate H, de Maat MP. Prognostic hemostasis biomarkers in acute ischemic stroke: a systematic review. Arterioscler Thromb Vasc Biol. 2019;39(3):360–72.
16. Van Kaam RC, van Putten MJ, Vermeer SE, Hofmeijer J. Contralesional brain activity in acute ischemic stroke. Cerebrovasc Dis. 2018;45(1-2):85-92.
17. Zhu Z, Xu T, Guo D, Huangfu X, Zhong C, Yang J, et al. Serum hepatocyte growth factor is probably associated with 3-month prognosis of acute ischemic stroke. Stroke. 2018;49(2):377-83.
18. Drayna PC, Abramo TJ, Estrada C. Near-infrared spectroscopy in the critical setting. Pediatr Emerg Care. 2011 May;27(5):432-9.
19. Joana M, Carolina MC, Liliane G, Manuel TC. Noninvasive Neurophysiological Monitoring in Acute Ischemic Stroke Treatment. J Neurol Neurosurg. 2017;4(1):555628.
20. Kim W, Taw B, Yokosako S, Koyanagi M, Fukuda H, Sinclair D, et al. The future of non-invasive cerebral oximetry in neurosurgical procedures: A systematic review. MNI Open Res. 2018;2(3): (
21. Hametner C, Stanarcevic P, Stampfl S, Rohde S, Veltkamp R, Bösel J, et al. Noninvasive cerebral oximetry during endovascular therapy for acute ischemic stroke: an observational study. J Cereb Blood Flow Metab. 2015;35(11):1722-8.
22. Elser HE, Holditch-Davis D, Brandon DH. Cerebral Oxygenation Monitoring: A Strategy to Detect IVH and PVL. Newborn Infant Nurs Rev. 2011;11(3): 153-9.
23. Shuler MS, Reisman WM, Whitesides TE Jr, Kinsey TL, Hammerberg EM, Davila MG, et al. Near-infrared spectroscopy in lower extremity trauma. J Bone Joint Surg Am. 2009;91(6):1360-8.
24. Hametner C, Stanarcevic P, Stampfl S, Rohde S, Veltkamp R, Bösel J. Noninvasive cerebral oximetry during endovascular therapy for acute ischemic stroke: an observational study. J Cereb Blood Flow Metab. 2015;35(11):1722-8.
25. Louis ED, Mayer SA, Rowland LP. Merritt's neurology. 13th edition. Lippincott Williams & Wilkins; 2015.
26. Balucani C, Levine SR, Khoury JC, Khatri P, Saver JL, Broderick JP. Acute ischemic stroke with very early clinical improvement: a national institute of neurological disorders and stroke recombinant tissue plasminogen activator stroke trials exploratory analysis. J Stroke Cerebrovasc Dis. 2016;25(4):894-901.
27. Jobsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science. 1977;198(4323):1264-7.
28. Orihashi K, Sueda T, Okada K, Imai K. Near-infrared spectroscopy for monitoring cerebral ischemia during selective cerebral perfusion. Eur J Cardiothorac Surg. 2004;26(5):907-11.
29. Roberts JS, Vavilala MS, Schenkman KA, Shaw D, Martin LD, Lam AM. Cerebral hyperemia and impaired cerebral autoregulation associated with diabetic ketoacidosis in critically ill children. Crit Care Med. 2006;34(8):2217-23.
30. Fortune PM, Wagstaff M, Petros AJ. Cerebro-splanchnic oxygenation ratio (CSOR) using near infrared spectroscopy may be able to predict splanchnic ischaemia in neonates. Intensive Care Med. 2001;27(8):1401-7.
31. Kirkness CJ, Burr RL, Cain KC, Newell DW, Mitchell PH. Effect of continuous display of cerebral perfusion pressure on outcomes in patients with traumatic brain injury. Am J Crit Care. 2006;15(6):600-9.
32. Adelson PD, Nemoto E, Colak A, Painter M. The use of near infrared spectroscopy (NIRS) in children after traumatic brain injury: a preliminary report. Acta Neurochir Suppl. 1998;71:250-4.
33. Giannotti G, Cohn SM, Brown M, Varela JE, McKenney MG, Wiseberg JA. Utility of near-infrared spectroscopy in the diagnosis of lower extremity compartment syndrome. J Trauma. 2000;48(3):396-401.
34. Plachky J, Hofer S, Volkmann M, Martin E, Bardenheuer HJ, Weigand MA. Regional cerebral oxygen saturation is a sensitive marker of cerebral hypoperfusion during orthotopic liver transplantation. Anesth Analg. 2004;99(2):344-9.
35. Shidoh S, Akiyama T, Ohira T, Yoshida K. Cerebral perfusion change of venous hypertension on near-infrared spectroscopy signals after operation for dural arteriovenous fistula. J Stroke Cerebrovasc Dis. 2014;23(5):823-8.
36. Mutoh T, Kobayashi S, Tamakawa N, Ishikawa T. Multichannel near-infrared spectroscopy as a tool for assisting intra-arterial fasudil therapy for diffuse vasospasm after subarachnoid hemorrhage. Surg Neurol Int. 2011; 2: 68.
37. Bhatia R, Hampton T, Malde S, Kandala NB, Muammar M, Deasy N, et al. The application of near-infrared oximetry to cerebral monitoring during aneurysm embolization: a comparison with intraprocedural angiography. J Neurosurg Anesthesiol. 2007;19(2):97-104.
38. Hiramatsu R, Furuse M, Yagi R, Ohnishi H, Ikeda N, Nonoguchi N, Kawabata S, Miyachi S, Kuroiwa T. Limit of intraoperative near-infrared spectroscopy monitoring during endovascular thrombectomy in acute ischemic stroke. Interv Neuroradiol. 2018;24(1):57-63.
39. Brott T, Bogousslavsky J. Treatment of acute ischemic stroke. N Engl J Med. 2000;343(10):710-22.
How to Cite
Paybast S, Ashraf A, Sarshad H, Shakiba M, Moadabi Y. Propagating Relationship of Cerebral Oximetric Volume and the Clinical Outcome of Recombinant Tissue Plasminogen Activator (r-TPA) Therapy on Acute Cerebral Ischemic Stroke Patients. Adv J Emerg Med. 4(1):e7.
Original article