title: Monitoring cerebral tissue oxygen saturation at frontal and parietal regions during carotid artery stenting.
abstract: Cerebral oximetry is normally placed on the upper forehead to monitor the frontal lobe cerebral tissue oxygen saturation (SctO2). We present a case in which the SctO2 was simultaneously monitored at both frontal and parietal regions during internal carotid artery (ICA) stenting. Our case involves a 79-year-old man who presented after a sudden fall and was later diagnosed with a watershed ischemic stroke in the distal fields perfused by the left middle cerebral artery. He had diffuse atherosclerotic occlusive lesions in the carotid and cerebral arterial systems including an 85 % stenotic lesion in the left distal cervical ICA. The brain territory perfused by the left ICA was devoid of collateral flow from anterior and posterior communicating arteries due to an abnormal circle of Willis. During stenting, the SctO2 monitored at both frontal and parietal regions tracked the procedure-induced acute flow change. However, the baseline SctO2 values of frontal and parietal regions differed. The SctO2-MAP correlation was more consistent on the stroked hemisphere than the non-stroked hemisphere. This case showed that SctO2 can be reliably monitored at the parietal region, which is primarily perfused by the ICA. SctO2 of the stroked brain is more pressure dependent than the non-stroked brain.
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco, 500 Parnassus Ave, Box 0648, San Francisco, CA, 94143, USA. meng.lingzhong@gmail.com.
authors.forename: Lingzhong
authors.initials: L
authors.lastname: Meng
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco, 500 Parnassus Ave, Box 0648, San Francisco, CA, 94143, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Hall
authors.affiliation: Division of Neuro Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Fabio
authors.initials: F
authors.lastname: Settecase
authors.affiliation: Division of Neuro Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Randall T
authors.initials: RT
authors.lastname: Higashida
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco, 500 Parnassus Ave, Box 0648, San Francisco, CA, 94143, USA.
authors.forename: Adrian W
authors.initials: AW
authors.lastname: Gelb
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal; D002536:Cerebral Arteries; D002560:Cerebrovascular Circulation; D006801:Humans; D008297:Male; D020768:Middle Cerebral Artery; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000378:metabolism*; D010296:Parietal Lobe; D015607:Stents; D020521:Stroke / Q000473:pathology
chemical_list: D010100:Oxygen
keywords: Carotid artery disease and stenting; Cerebral oximetry; Cerebral perfusion pressure dependency; Frontal and parietal monitoring; Watershed stroke