Evaluation of TPA effectiveness in acute stroke patients with nirs (near-infrared spectroscopy)

Introduction: Acute ischemic stroke is one of the most important neurological emergencies that leads to neurological deficits with sudden onset. Thrombolytic therapy is the only treatment that has proven effective in four and half hours. In this study investigators aimed to evaluate the success of treatment by using near-infrared spectroscopy in patients receiving thrombolytic therapy in the emergency department due to acute ischemic stroke, to determine the success level of the treatment with objective parameters and to determine its usability in early recognition of the complications. Materials and Method: This prospective, analytical study included forty-one patients who underwent thrombolytic therapy due to acute ischemic stroke in Dokuz Eylül University Faculty of Medicine Emergency Department, between 30.11.2017-01.10.2018. Vital parameters, GCS, rSO2 (regional saturation obtained with near-infrared spectroscopy) and NIHSS values at the admission time and 0th 15th 30th 45th 60th 120th minutes of the thrombolytic therapy and demographic data of the patients were recorded. Patients were classified as the clinical improvement group (CI group), clinical deterioration group (CD group) and without clinical change group (WCC group). Results: 41 patients enrolled to analysis, mean age was 73.6 ± 14.8 and the female / male ratio was 1.7. Evaluation of the rSO2 at the 0th, 15th, 30th, 45th, 60th and 120th minutes of the thrombolytic therapy showed that there was a significant difference in the affected hemisphere rSO2 of participants with clinical improvement (n=15) (p <0.01). Also, there was a significant difference between the participants with clinical deterioration (n=5) and the affected hemisphere rSO2 (p <0.02). Study showed no significant difference between the affected and unaffected hemisphere rSO2 of the all participants (n = 41). There was no significant difference between the affected and unaffected hemisphere rSO2 of participants without clinical change (n=21) (p> 0.05). Comparison of the participants the mean of rSO2 in the affected hemisphere with clinical improvement and clinical deterioration showed; mean rSO2 was significantly higher in the group with clinical improvement (p <0.01), and rSO2 was lower in patients with clinical deterioration (p = 0.04). There was a significant difference between the admission and 120th minute delta rSO2 values in group showing clinical improvement (p <0.02) and study showed no significant difference in the measurements of delta rSO2 in other groups (absence of clinical change, clinical deterioration). One participant in our study had seizures and one participant had respiratory arrest. It was observed that the rSO2 values decreased before the clinical presentations of adverse events in these patients, showing that NIRS can be used as an early warning system. Conclusion: In this trial rSO2 changes were increased in clinical improved group and detoriated in clinical detoriated group. No significant change observed in participants with any clinical change. Cerebral near-infrared spectroscopy can be used as a safe and routine monitorization method to provide an objective measurement in patients with acute ischemic stroke recieving thrombolytic therapy. Cerebral NIRS monitorization also showed changes before clinical detoriation therefore can be used as an effective method for monitoring the complications as an early warning system. (Funded by Dokuz Eylül Unıversıty Scientific Research Project Support Department; ClinicalTrials.gov number, NCT03621917). Keywords: acute ischemic stroke, thrombolytic theraphy, near-infrared spectroscopy, emergency department, cerebral monitorisation, r-tpa