Brain circulation · 2025
Effect of cerebral oxygen saturation on outcomes of patients with ruptured intracranial aneurysms undergoing endovascular embolization: A prospective observational study.
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Giribabu Parthiban, Venkat Sudhir, Reddy K R Madhusudan, Chakrabarti Dhritiman, Aravinda H R, Palaniswamy Sangeetha R
Аннотация
BACKGROUND: Subarachnoid hemorrhage secondary to ruptured intracranial aneurysms compromise cerebral perfusion and oxygenation, threatening optimal cerebral function. This study explored the role of regional cerebral oxygenation monitoring in predicting outcomes in these patients.
METHODOLOGY: Fifty-two patients aged 18-65 years and scheduled for coiling of ruptured anterior circulation aneurysms participated in this prospective observational study. Bilateral regional cerebral oxygen saturation (rScO2) was recorded during critically important phases of endovascular embolization under general anesthesia. rScO2 was continuously monitored and recorded at critical stages of the procedure. Vital parameters and rScO2 were collected at baseline, preinduction, postintubation, 5 min postintubation, and continuously after that, till the end of the procedure. Intraprocedural events such as contrast injection, sequential coil deployment, milrinone injections, and complications such as thromboembolism, coil migration, and aneurysmal rupture were event-marked, and the vital parameters along with bilateral near-infrared spectroscopy values were noted before and after each of these events. Cerebral desaturation episode (CDE) was defined as a drop in rScO2 by 20% from baseline. Postprocedure, patients were monitored with a 24-h Glasgow Coma Scale during their hospital stay and a Glasgow outcome at discharge scale (GODS).
RESULTS: Among the 52 recruited patients, 10 patients had CDEs. Increased frequency of CDEs correlated with the GODS score at discharge (P = 0.040), length of hospital stay (P < 0.001), duration of neurological deficit (P = 0.001), and vasospasm (P = 0.002).
CONCLUSION: The frequency of CDEs and the trend of decline in rScO2 from the baseline are predictive of an endangered hypoxic brain prone to secondary brain injuries, which guides the institution of prompt corrective measures.TRIAL REGISTRATION: https://ctri.nic.in/Clinicaltrials (identifier: CTRI/2021/09/036253).
METHODOLOGY: Fifty-two patients aged 18-65 years and scheduled for coiling of ruptured anterior circulation aneurysms participated in this prospective observational study. Bilateral regional cerebral oxygen saturation (rScO2) was recorded during critically important phases of endovascular embolization under general anesthesia. rScO2 was continuously monitored and recorded at critical stages of the procedure. Vital parameters and rScO2 were collected at baseline, preinduction, postintubation, 5 min postintubation, and continuously after that, till the end of the procedure. Intraprocedural events such as contrast injection, sequential coil deployment, milrinone injections, and complications such as thromboembolism, coil migration, and aneurysmal rupture were event-marked, and the vital parameters along with bilateral near-infrared spectroscopy values were noted before and after each of these events. Cerebral desaturation episode (CDE) was defined as a drop in rScO2 by 20% from baseline. Postprocedure, patients were monitored with a 24-h Glasgow Coma Scale during their hospital stay and a Glasgow outcome at discharge scale (GODS).
RESULTS: Among the 52 recruited patients, 10 patients had CDEs. Increased frequency of CDEs correlated with the GODS score at discharge (P = 0.040), length of hospital stay (P < 0.001), duration of neurological deficit (P = 0.001), and vasospasm (P = 0.002).
CONCLUSION: The frequency of CDEs and the trend of decline in rScO2 from the baseline are predictive of an endangered hypoxic brain prone to secondary brain injuries, which guides the institution of prompt corrective measures.TRIAL REGISTRATION: https://ctri.nic.in/Clinicaltrials (identifier: CTRI/2021/09/036253).