Evaluation of IV thrombolysis and/or mechanical thrombectomy treatment in acute stroke patients with near infrared spectroscopy (NİRS)

Objective: Acute ischemic stroke; it is an emergency clinical situation that develops suddenly, causes focal neurological deficit, lasts longer than 24 hours and partially or completely recovers within days or causes permanent disability and death. It is the most common cause of morbidity and the main cause of mortality. Therefore, stroke is an important health problem in Turkey and in the world. Neurological outcome and survival are positively affected by IV thrombolysis and mechanical thrombectomy, which are applied early in the treatment of stroke. Our aim; To use NIRS, which measures cerebral oxygenation, as an objective monitoring method that shows the success of treatment or detects possible complications with treatment early. Materials and Methods: This study was approved by the ethics committee and applied to the Emergency Service of Recep Tayyip Erdoğan University Training and Research Hospital with the reason of acute ischemic stroke who underwent IV thrombolysis and/or mechanical thrombectomy treatments. It was performed prospectively on 80 patients. Age, gender, application complaints, time of application, additional diseases, drugs used were recorded in the study form. The patients who underwent IV thrombolysis at admission, 0th, 15th, 30th, 45th, 60th minutes of treatment, post-treatment vital parameters, GCS, NIHSS and NIRS values, pre- and post-treatment GCS, NIHSS and NIRS values of patients who underwent mechanical thrombectomy were studied in the study form. Laboratory values and imaging methods obtained from the hospital information system were recorded in the study form. The patients were evaluated by grouping them as clinical improvement, clinical worsening, and no clinical change. Results: Of the 80 patients included in the study, 50 (62.5%) were female and 30 (37.5%) were male. The median age of the patients was 76 (23-94). While there was a significant difference between the NIRS values measured during and after treatment in the ischemic hemisphere in patients given intravenous thrombolysis and clinical improvement (n=27), there was no significant difference in the non-ischemic hemisphere (p=0.071). There was vii no significant difference between the NIRS values measured during and after treatment in ischemic and non-ischemic hemispheres in patients with clinical worsening (n=12) (p>0.05). There was no significant difference between the NIRS values measured during and after treatment in ischemic and non-ischemic hemispheres in patients without clinical change (n=28) (p>0.05). There was a significant difference between the difference in NIRS values (Delta NIRS) between the ischemic and non-ischemic hemispheres of the patients who underwent mechanical thrombectomy (n=22) before and after the procedure (p=0.017). There was a strong and significant negative correlation between the deltaNIHSS value and the deltaNIRS values in the ischemic hemisphere in all patients (n=74) except the intubated patients included in the study (r=-0.307, p=0.013). Although there was a weak negative correlation between the deltaNIHSS value and the deltaNIRS values in the non-ischemic hemisphere, there was no significant difference (r=-0.092, p=0.467). Conclusion: We think that IV thrombolysis and/or mechanical thrombectomy treatment applied in patients admitted to the emergency department with acute ischemic stroke can be followed objectively with NIRS. Keywords: acute ischemic stroke, thrombolysis, thrombectomy, NIRS, emergency department