Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 6:19:e20190027.
doi: 10.1590/1677-5449.190027.

Evaluation of the brain hemodynamic response by means of near-infrared spectroscopy (NIRS) monitoring in patients with atherosclerotic carotid disease undergoing endarterectomy

Letícia Cristina Dalledone Siqueira Rein  1 , Daniel Emílio Dalledone Siqueira  1 , Ana Terezinha Guillaumon  1 , Wagner Mauad Avelar  1 , Fernando Cendes  1 , Rickson Coelho Mesquita  1
Affiliations

Evaluation of the brain hemodynamic response by means of near-infrared spectroscopy (NIRS) monitoring in patients with atherosclerotic carotid disease undergoing endarterectomy

Letícia Cristina Dalledone Siqueira Rein et al. J Vasc Bras. .

Abstract
in English, Portuguese

Backgrounds: Near-infrared spectroscopy (NIRS) is non-invasive technique that detects hemodynamic alterations in tissues. It enables continuous monitoring of intracerebral vascular physiologic information. Due to its portable nature, NIRS may be used bedside or in the operating room.

Objectives: To evaluate use of NIRS for intraoperative monitoring of the brain hemodynamic response, during carotid endarterectomy.

Methods: 10 patients with atherosclerotic carotid disease scheduled for endarterectomy were evaluated. After patients had been selected, they answered a questionnaire on epidemiological data and information about comorbidities and then carotid disease was confirmed with diagnostic methods. NRIS monitoring was used during the surgical procedure. The variables analyzed before, during and after carotid clamping were oxygen saturation (SatO2), total hemoglobin (THb), reduced hemoglobin (RHb), and oxyhemoglobin (OHb). A p value of <0.05 was considered statistically significant.

Results: The results obtained from NIRS show that RHb and SatO2 vary during the different stages of surgery. RHb levels are higher during clamping, when compared with the other two surgical stages. On the other hand, SatO2 is lower during clamping.

Conclusions: During carotid endarterectomy, NIRS is a feasible, real-time, and non-invasive intracranial monitoring method that accurately and reliably measures the changes in intracerebral capillary hemodynamic conditions.

Contexto: A espectroscopia próxima ao infravermelho (NIRS) é uma técnica não invasiva que detecta as alterações hemodinâmicas teciduais. A NIRS pode monitorar de forma contínua as informações fisiológicas vasculares intracranianas. Por ser portátil, ela pode ser utilizada à beira do leito e no centro cirúrgico.

Objetivos: Avaliar as possíveis alterações hemodinâmicas cerebrais durante a endarterectomia em pacientes com estenoses maiores que 70% utilizando NIRS.

Métodos: Foram avaliados 10 voluntários portadores de doença carotídea aterosclerótica com indicação de endarterectomia. Após a seleção dos pacientes, que responderam um questionário com dados epidemiológicos e informações referentes à presença de comorbidades, a doença foi confirmada por métodos diagnósticos. No procedimento cirúrgico, utilizou-se a NIRS para monitorização. Foram avaliadas as variáveis saturação de oxigênio (SatO2), hemoglobina total (HbT), hemoglobina reduzida (HbR) e hemoglobina oxigenada (HbO) nos três tempos cirúrgicos pré-, trans e pós-clampeamento carotídeo. Utilizou-se p < 0,05 como nível de significância.

Resultados: A avaliação dos resultados obtidos por meio das medidas registradas pela NIRS permite afirmar que HbR e SatO2 variam ao longo das etapas da cirurgia. Durante o clampeamento, a variável HbR mostra valores mais elevados que nas outras duas etapas da cirurgia. Por outro lado, a variável SatO2 mostra redução durante o clampeamento.

Conclusões: A NIRS é um método viável e aplicável de monitorização intracerebral, não invasivo e em tempo real, durante a endarterectomia carotídea, capaz de medir de forma precisa as mudanças das condições hemodinâmicas capilares intracerebrais.

Keywords: carotid artery disease; carotid endarterectomy; carotid stenosis; near-infrared spectroscopy.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. The NIRS machine.
Figure 2
Figure 2. Placement of the NIRS optical probe.
Figure 3
Figure 3. Graph obtained from NIRS monitoring of volunteer 9, showing, on the x-axis, time in minutes and, on the y-axis, oxygen saturation (SatO2; %) in magenta, oxyhemoglobin (HbO; micro mol) in red, reduced hemoglobin (HbR; micro mol) in blue, and total hemoglobin (HbT; micro mol) in green; the shaded area indicates clamping.
Figure 4
Figure 4. Fitted polynomials for volunteer 9, where the “before clamping” phase is in blue, the “during clamping” phase is in red, and the “after clamping” phase is in green, for each of the four variables employed (SatO2, HbO, HbR, and HbT).
Figura 1
Figura 1. Detalhe do aparelho de NIRS.
Figura 2
Figura 2. Posicionamento da sonda óptica da NIRS.
Figura 3
Figura 3. Gráfico obtido com a monitorização por NIRS no voluntário 9, demonstrando, no eixo x, o tempo em minutos e, no eixo y, a saturação de oxigênio (SatO2; %) em lilás, a hemoglobina oxigenada (HbO; micro mol) em vermelho, a hemoglobina reduzida (HbR; micro mol) em azul e a hemoglobina total (HbT; micro mol) em verde; a área sombreada corresponde ao clampeamento.
Figura 4
Figura 4. Polinômios ajustados para o indivíduo 9, em que a etapa pré-clampeamento está representada em azul, o clampeamanto em vermelho e o pós-clampeamento em verde para cada uma das quatro variáveis utilizadas (SatO2, HbO, HbR, HbT).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Uchino H, Nakamura T, Kuroda S, Houkin K, Murata J, Saito H. Intraoperative dual monitoring during carotid endarterectomy using motor evoked potentials and near-infrared spectroscopy. World Neurosurg. 2012;78(6):651–657. doi: 10.1016/j.wneu.2011.10.039. - DOI - PubMed
    1. Ascher E, Markevich N, Hingorani AP, Kallakuri S, Gunduz Y. Internal carotid artery flow volume measurement and other intraoperative duplex scanning parameters as predictors of stroke after carotid endarterectomy. J Vasc Surg. 2002;35(3):439–444. doi: 10.1067/mva.2002.120044. - DOI - PubMed
    1. Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth. 2009;103(Suppl 1):i3–13. doi: 10.1093/bja/aep299. - DOI - PubMed
    1. Becquemin JP, Alimi YS, Watelet J, Loisance D. Controversies and update in vascular and cardiac surgery. Torino, Italy: Edizioni Minerva Medica; 2004.
    1. Sloan MA. Prevention of ischemic neurologic injury with intraoperative monitoring of selected cardiovascular and cerebrovascular procedures: roles of electroencephalography, somatosensory evoked potentials, transcranial Doppler, and near-infrared spectroscopy. Neurol Clin. 2006;24(4):631–645. doi: 10.1016/j.ncl.2006.05.002. - DOI - PubMed

LinkOut - more resources