Key result
Stroke requiring surgical decompression linked to ~37-point lower cortical vessel perfusion vs controls.
Why the study?
Data on microcirculation in the human brain during ischemic stroke are limited due to lack of appropriate investigational techniques.
Does sidestream dark-field imaging detect alterations in cortical microcirculation in terms of blood flow and vessel density in patients with stroke requiring surgical decompression compared with a control group?
Observational (n=11)
No
Does sidestream dark-field imaging detect alterations in cortical microcirculation in terms of blood flow and vessel density in patients with stroke requiring surgical decompression compared with a control group?
Absolute Event Rate: 63.44% vs 100%
Sidestream dark-field imaging during decompressive craniectomy effectively visualizes human cerebral microcirculation in vivo, demonstrating significant reductions in blood flow and vascular density following space-occupying hemispheric infarction.
Objectives Most knowledge related to the pathophysiology of microcirculation in ischemic stroke comes from experimental research. Unfortunately, data on microcirculation in the human brain are limited, partially as a result of the lack of appropriate investigational techniques. The objective of our study was to test the hypothesis that cortical microcirculatory alterations in the brain, in terms of blood flow and vessel density, occur in patients with stroke who require surgical decompression compared with a control group. Design Prospective and observational study. Setting Third-level university hospital. Patients Six patients who had undergone decompressive surgery as a result of a space-occupying hemispheric infarction. These patients were compared with five patients who had undergone craniotomy for a disease not affecting the cortex. Interventions Cortical microcirculation in the brain was directly observed using sidestream dark-field imaging. All images were analyzed offline. Measurements and main results In patients with stroke with a space-occupying hemispheric infarction, 18 good-quality movie images were compared with 25 control group images. In the control group, cortical vessels showed a continuous flow in small, medium, and large vessels compared with patients with stroke who presented intermittent or no flow in all vessels. The proportion of perfused vessels was near 100% in control subjects and 63.44% in patients with stroke. The perfused vessel density index was also higher in control subjects (6.16 1/mm; interquartile range, 5.65-7.56) than in patients with stroke (2.77 1/mm; interquartile range, 1.75-3.86). Conclusion Sidestream dark-field imaging allowed direct visualization of cerebral microcirculatory alterations in the operating room. This technique allowed the documentation of a significant blood flow reduction in the cortical microvascular and a decreased vascular density in patients with stroke compared with control subjects.
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Pérez‐Bárcena et al. (2011) conducted an observational in Ischemic stroke with space-occupying hemispheric infarction (n=11). Space-occupying hemispheric infarction vs. Patients undergoing craniotomy for a disease not affecting the cortex was evaluated on Proportion of perfused vessels. Patients with stroke requiring surgical decompression had a lower proportion of perfused cortical vessels (63.44% vs near 100%) and decreased vascular density compared to controls.
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