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Favilla CG, Forti RM, Carter S, Kofke WA, Kasner SE, Baker WB, Yodh AG, Messé SR, Cummings S, Kung DK, Burkhardt JK, Choudhri OA, Pukenas B, Srinivasan VM, Hurst RW, Detre JA. Microvascular reperfusion during endovascular therapy: the balance of supply and demand. J Neurointerv Surg 2023:jnis-2023-020834. [PMID: 37898551 PMCID: PMC11055937 DOI: 10.1136/jnis-2023-020834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/03/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Endovascular therapy (EVT) has revolutionized the treatment of acute stroke, but large vessel recanalization does not always result in tissue-level reperfusion. Cerebral blood flow (CBF) is not routinely monitored during EVT. We aimed to leverage diffuse correlation spectroscopy (DCS), a novel transcranial optical imaging technique, to assess the relationship between microvascular CBF and post-EVT outcomes. METHODS Frontal lobe CBF was monitored by DCS in 40 patients undergoing EVT. Baseline CBF deficit was calculated as the percentage of CBF impairment on pre-EVT CT perfusion. Microvascular reperfusion was calculated as the percentage increase in DCS-derived CBF that occurred with recanalization. The adequacy of reperfusion was defined by persistent CBF deficit, calculated as: baseline CBF deficit - microvascular reperfusion. A good functional outcome was defined as 90-day modified Rankin Scale score ≤2. RESULTS Thirty-six of 40 patients achieved successful recanalization, in whom microvascular reperfusion in itself was not associated with infarct volume or functional outcome. However, patients with good functional outcomes had a smaller persistent CBF deficit (median 1% (IQR -11%-16%)) than patients with poor outcomes (median 28% (IQR 2-50%)) (p=0.02). Smaller persistent CBF deficit was also associated with smaller infarct volume (p=0.004). Multivariate models confirmed that persistent CBF deficit was independently associated with infarct volume and functional outcome. CONCLUSIONS CBF augmentation alone does not predict post-EVT outcomes, but when microvascular reperfusion closely matches the baseline CBF deficit, patients experience favorable clinical and radiographic outcomes. By recognizing inadequate reperfusion, bedside CBF monitoring may provide opportunities to personalize post-EVT care aimed at CBF optimization.
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Affiliation(s)
- Christopher G Favilla
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rodrigo M Forti
- Department of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sarah Carter
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - W Andrew Kofke
- Department of Anesthesia & Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wesley B Baker
- Department of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Arjun G Yodh
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephanie Cummings
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David K Kung
- Department of Neurosurgery, Robert Wood Johnson Health System, Livingston, New Jersey, USA
| | - Jan Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Omar A Choudhri
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bryan Pukenas
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert W Hurst
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ayaz H, Baker WB, Blaney G, Boas DA, Bortfeld H, Brady K, Brake J, Brigadoi S, Buckley EM, Carp SA, Cooper RJ, Cowdrick KR, Culver JP, Dan I, Dehghani H, Devor A, Durduran T, Eggebrecht AT, Emberson LL, Fang Q, Fantini S, Franceschini MA, Fischer JB, Gervain J, Hirsch J, Hong KS, Horstmeyer R, Kainerstorfer JM, Ko TS, Licht DJ, Liebert A, Luke R, Lynch JM, Mesquida J, Mesquita RC, Naseer N, Novi SL, Orihuela-Espina F, O’Sullivan TD, Peterka DS, Pifferi A, Pollonini L, Sassaroli A, Sato JR, Scholkmann F, Spinelli L, Srinivasan VJ, St. Lawrence K, Tachtsidis I, Tong Y, Torricelli A, Urner T, Wabnitz H, Wolf M, Wolf U, Xu S, Yang C, Yodh AG, Yücel MA, Zhou W. Optical imaging and spectroscopy for the study of the human brain: status report. NEUROPHOTONICS 2022; 9:S24001. [PMID: 36052058 PMCID: PMC9424749 DOI: 10.1117/1.nph.9.s2.s24001] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This report is the second part of a comprehensive two-part series aimed at reviewing an extensive and diverse toolkit of novel methods to explore brain health and function. While the first report focused on neurophotonic tools mostly applicable to animal studies, here, we highlight optical spectroscopy and imaging methods relevant to noninvasive human brain studies. We outline current state-of-the-art technologies and software advances, explore the most recent impact of these technologies on neuroscience and clinical applications, identify the areas where innovation is needed, and provide an outlook for the future directions.
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Affiliation(s)
- Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science, and Health Systems, Philadelphia, Pennsylvania, United States
- Drexel University, College of Arts and Sciences, Department of Psychological and Brain Sciences, Philadelphia, Pennsylvania, United States
| | - Wesley B. Baker
- Children’s Hospital of Philadelphia, Division of Neurology, Philadelphia, Pennsylvania, United States
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Giles Blaney
- Tufts University, Department of Biomedical Engineering, Medford, Massachusetts, United States
| | - David A. Boas
- Boston University Neurophotonics Center, Boston, Massachusetts, United States
- Boston University, College of Engineering, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Heather Bortfeld
- University of California, Merced, Departments of Psychological Sciences and Cognitive and Information Sciences, Merced, California, United States
| | - Kenneth Brady
- Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Department of Anesthesiology, Chicago, Illinois, United States
| | - Joshua Brake
- Harvey Mudd College, Department of Engineering, Claremont, California, United States
| | - Sabrina Brigadoi
- University of Padua, Department of Developmental and Social Psychology, Padua, Italy
| | - Erin M. Buckley
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States
| | - Stefan A. Carp
- Massachusetts General Hospital, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
| | - Robert J. Cooper
- University College London, Department of Medical Physics and Bioengineering, DOT-HUB, London, United Kingdom
| | - Kyle R. Cowdrick
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Joseph P. Culver
- Washington University School of Medicine, Department of Radiology, St. Louis, Missouri, United States
| | - Ippeita Dan
- Chuo University, Faculty of Science and Engineering, Tokyo, Japan
| | - Hamid Dehghani
- University of Birmingham, School of Computer Science, Birmingham, United Kingdom
| | - Anna Devor
- Boston University, College of Engineering, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Turgut Durduran
- ICFO – The Institute of Photonic Sciences, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
- Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
| | - Adam T. Eggebrecht
- Washington University in St. Louis, Mallinckrodt Institute of Radiology, St. Louis, Missouri, United States
| | - Lauren L. Emberson
- University of British Columbia, Department of Psychology, Vancouver, British Columbia, Canada
| | - Qianqian Fang
- Northeastern University, Department of Bioengineering, Boston, Massachusetts, United States
| | - Sergio Fantini
- Tufts University, Department of Biomedical Engineering, Medford, Massachusetts, United States
| | - Maria Angela Franceschini
- Massachusetts General Hospital, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
| | - Jonas B. Fischer
- ICFO – The Institute of Photonic Sciences, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Judit Gervain
- University of Padua, Department of Developmental and Social Psychology, Padua, Italy
- Université Paris Cité, CNRS, Integrative Neuroscience and Cognition Center, Paris, France
| | - Joy Hirsch
- Yale School of Medicine, Department of Psychiatry, Neuroscience, and Comparative Medicine, New Haven, Connecticut, United States
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
| | - Keum-Shik Hong
- Pusan National University, School of Mechanical Engineering, Busan, Republic of Korea
- Qingdao University, School of Automation, Institute for Future, Qingdao, China
| | - Roarke Horstmeyer
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
- Duke University, Department of Electrical and Computer Engineering, Durham, North Carolina, United States
- Duke University, Department of Physics, Durham, North Carolina, United States
| | - Jana M. Kainerstorfer
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
- Carnegie Mellon University, Neuroscience Institute, Pittsburgh, Pennsylvania, United States
| | - Tiffany S. Ko
- Children’s Hospital of Philadelphia, Division of Cardiothoracic Anesthesiology, Philadelphia, Pennsylvania, United States
| | - Daniel J. Licht
- Children’s Hospital of Philadelphia, Division of Neurology, Philadelphia, Pennsylvania, United States
| | - Adam Liebert
- Polish Academy of Sciences, Nalecz Institute of Biocybernetics and Biomedical Engineering, Warsaw, Poland
| | - Robert Luke
- Macquarie University, Department of Linguistics, Sydney, New South Wales, Australia
- Macquarie University Hearing, Australia Hearing Hub, Sydney, New South Wales, Australia
| | - Jennifer M. Lynch
- Children’s Hospital of Philadelphia, Division of Cardiothoracic Anesthesiology, Philadelphia, Pennsylvania, United States
| | - Jaume Mesquida
- Parc Taulí Hospital Universitari, Critical Care Department, Sabadell, Spain
| | - Rickson C. Mesquita
- University of Campinas, Institute of Physics, Campinas, São Paulo, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, São Paulo, Brazil
| | - Noman Naseer
- Air University, Department of Mechatronics and Biomedical Engineering, Islamabad, Pakistan
| | - Sergio L. Novi
- University of Campinas, Institute of Physics, Campinas, São Paulo, Brazil
- Western University, Department of Physiology and Pharmacology, London, Ontario, Canada
| | | | - Thomas D. O’Sullivan
- University of Notre Dame, Department of Electrical Engineering, Notre Dame, Indiana, United States
| | - Darcy S. Peterka
- Columbia University, Zuckerman Mind Brain Behaviour Institute, New York, United States
| | | | - Luca Pollonini
- University of Houston, Department of Engineering Technology, Houston, Texas, United States
| | - Angelo Sassaroli
- Tufts University, Department of Biomedical Engineering, Medford, Massachusetts, United States
| | - João Ricardo Sato
- Federal University of ABC, Center of Mathematics, Computing and Cognition, São Bernardo do Campo, São Paulo, Brazil
| | - Felix Scholkmann
- University of Bern, Institute of Complementary and Integrative Medicine, Bern, Switzerland
- University of Zurich, University Hospital Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zürich, Switzerland
| | - Lorenzo Spinelli
- National Research Council (CNR), IFN – Institute for Photonics and Nanotechnologies, Milan, Italy
| | - Vivek J. Srinivasan
- University of California Davis, Department of Biomedical Engineering, Davis, California, United States
- NYU Langone Health, Department of Ophthalmology, New York, New York, United States
- NYU Langone Health, Department of Radiology, New York, New York, United States
| | - Keith St. Lawrence
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Department of Medical Biophysics, London, Ontario, Canada
| | - Ilias Tachtsidis
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
| | - Yunjie Tong
- Purdue University, Weldon School of Biomedical Engineering, West Lafayette, Indiana, United States
| | - Alessandro Torricelli
- Politecnico di Milano, Dipartimento di Fisica, Milan, Italy
- National Research Council (CNR), IFN – Institute for Photonics and Nanotechnologies, Milan, Italy
| | - Tara Urner
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Heidrun Wabnitz
- Physikalisch-Technische Bundesanstalt (PTB), Berlin, Germany
| | - Martin Wolf
- University of Zurich, University Hospital Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zürich, Switzerland
| | - Ursula Wolf
- University of Bern, Institute of Complementary and Integrative Medicine, Bern, Switzerland
| | - Shiqi Xu
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
| | - Changhuei Yang
- California Institute of Technology, Department of Electrical Engineering, Pasadena, California, United States
| | - Arjun G. Yodh
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - Meryem A. Yücel
- Boston University Neurophotonics Center, Boston, Massachusetts, United States
- Boston University, College of Engineering, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Wenjun Zhou
- University of California Davis, Department of Biomedical Engineering, Davis, California, United States
- China Jiliang University, College of Optical and Electronic Technology, Hangzhou, Zhejiang, China
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4
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Forti RM, Katsurayama M, Menko J, Valler L, Quiroga A, Falcão ALE, Li LM, Mesquita RC. Real-Time Non-invasive Assessment of Cerebral Hemodynamics With Diffuse Optical Spectroscopies in a Neuro Intensive Care Unit: An Observational Case Study. Front Med (Lausanne) 2020; 7:147. [PMID: 32411712 PMCID: PMC7198738 DOI: 10.3389/fmed.2020.00147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/06/2020] [Indexed: 12/30/2022] Open
Abstract
Prevention of secondary damage is an important goal in the treatment of severe neurological conditions, such as major head trauma or stroke. However, there is currently a lack of non-invasive methods for monitoring cerebral physiology. Diffuse optical methods have been proposed as an inexpensive, non-invasive bedside monitor capable of providing neurophysiology information in neurocritical patients. However, the reliability of the technique to provide accurate longitudinal measurement during the clinical evolution of a patient remains largely unaddressed. Here, we report on the translation of a hybrid diffuse optical system combining frequency domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS) for real-time monitoring of cerebral physiology in a neuro intensive care unit (neuro-ICU). More specifically, we present a case study of a patient admitted with a high-grade aneurysmal subarachnoid hemorrhage, who was monitored throughout hospitalization. We show that the neurophysiological parameters measured by diffuse optics at the bedside are consistent with the clinical evolution of the patient at all the different stages following its brain lesion. These data provide support for clinical translation of DOS/DCS as a useful biomarker of neurophysiology in the neuro-ICU, particularly in locations where other clinical resources are limited.
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Affiliation(s)
- Rodrigo M Forti
- Institute of Physics, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Marilise Katsurayama
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil.,Clinical Hospital, University of Campinas, Campinas, Brazil
| | - Julien Menko
- Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Lenise Valler
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil.,Clinical Hospital, University of Campinas, Campinas, Brazil
| | - Andres Quiroga
- Institute of Physics, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | | | - Li M Li
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil.,School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Rickson C Mesquita
- Institute of Physics, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
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