Prediction of the outcome of endovascular treatment in acute ischemic stroke patients

Abstract

The present application provides for use of a somatosensory evoked potential (SEP) during the hyperacute stroke phase as marker for predicting the outcome of endovascular treatment in a patient suffering from acute ischemic stroke, wherein when the SEP ipsilateral to the stroke site has an amplitude from 60% to 100% with respect to the corresponding SEP contralateral to the stroke site this is indicative of good outcome of the endovascular treatment, whereas when the SEP ipsilateral to the stroke site has an amplitude from 0% to 20% with respect to the corresponding SEP contralateral to the stroke site this is indicative of bad outcome of the endovascular treatment.

1 . A method for monitoring or prognosing a patient suffering from acute ischemic stroke, the method comprising (i) eliciting somatosensory evoked potentials (SEPs) that are ipsilateral and contralateral to a stroke site of the patient using an apparatus, (ii) measuring the ipsilateral and contralateral SEPs with the apparatus, and (iii) evaluating a response of the patient to an endovascular treatment, wherein:
 the apparatus comprises:
 (a) one or more stimulating electrodes located on each upper limb of the patient for stimulating a median nerve, an ulnar nerve, or a combination thereof, 
 (b) at least two recording electrodes located on the scalp of the patient for recording the ipsilateral and contralateral SEPs, and 
 (c) a monitoring system; 
   wherein the apparatus is configured to record the ipsilateral and contralateral SEPs from both hemispheres of the brain of the patient using the at least two recording electrodes; and   wherein the apparatus is configured to record at least one of N20 and P25 components of the ipsilateral and contralateral SEPs using the at least two recording electrodes located on the scalp of the patient; and   wherein an ipsilateral SEP having an amplitude from 60% to 100% with respect to a contralateral SEP indicates a desired response of the patient to the endovascular treatment.   
     
     
         2 . The method according to  claim 1 , wherein the ipsilateral and contralateral SEPs are elicited by stimulating the median nerve of the patient. 
     
     
         3 . The method according to  claim 1 , wherein the N20 component of the ipsilateral and contralateral SEPs is recorded using the at least two electrodes located on the scalp of the patient. 
     
     
         4 . The method according to  claim 1 , wherein the P25 component of the ipsilateral and contralateral SEPs is recorded using the at least two electrodes located on the scape of the patient. 
     
     
         5 - 6 . (canceled) 
     
     
         7 . The method according to  claim 1 , wherein the SEPs are measured within 8 h from stroke onset. 
     
     
         8 . The method according to  claim 7 , wherein the SEPs are measured within 6 h from stroke onset. 
     
     
         9 . The method according to  claim 1 , wherein the patient presents with anterior large vessel occlusion. 
     
     
         10 . The method according to  claim 1 , wherein the patient presents a clinical status as defined by the National Institutes of Health Stroke Scale (NUBS) equal or above 10. 
     
     
         11 . (canceled) 
     
     
         12 . The method according to  claim 1 , wherein the endovascular treatment is mechanical thrombectomy. 
     
     
         13 . The method according to  claim 1 , wherein the ipsilateral and contralateral SEPs are elicited by stimulating the ulnar nerve of the patient. 
     
     
         14 . The method according to  claim 1 , wherein the ipsilateral and contralateral SEPs are elicited by stimulating both the ulnar nerve and the median nerve of the patient. 
     
     
         15 . The method according to  claim 1 , wherein both the N20 and P25 components of the ipsilateral and contralateral SEPs are recorded using the at least two electrodes located on the scalp of the patient. 
     
     
         16 . The method according to  claim 1 , wherein the apparatus is configured to record the ipsilateral and contralateral SEPs from C3′ and C4′ positions of the scalp of the patient using the at least two recording electrodes. 
     
     
         17 . The method according to  claim 1 , wherein the SEPs are measured within 120 min after arrival of the patient to a hospital. 
     
     
         18 . The method according to  claim 1 , wherein the SEPs are measured before the endovascular treatment, during the endovascular treatment, or a combination thereof. 
     
     
         19 . A method for monitoring or prognosing a patient suffering from acute ischemic stroke, the method comprising (i) eliciting somatosensory evoked potentials (SEPs) that are ipsilateral and contralateral to a stroke site of the patient using an apparatus, (ii) measuring the ipsilateral and contralateral SEPs with the apparatus, and (iii) evaluating a response of the patient to an endovascular treatment, wherein:
 the apparatus comprises:
 (a) one or more stimulating electrodes located on each lower limb of the patient for stimulating a tibial nerve, 
 (b) at least two recording electrodes located on the scalp of the patient for recording the ipsilateral and contralateral SEPs, and 
 (c) a monitoring system; 
   wherein the apparatus is configured to record the ipsilateral and contralateral SEPs from both hemispheres of the brain of the patient using the at least two recording electrodes;   wherein the apparatus is configured to record at least one of N35 and P40 components of the ipsilateral and contralateral SEPs using the at least two recording electrodes located on the scalp of the patient; and   wherein an ipsilateral SEPhaving an amplitude from 60% to 100% with respect to a contralateral SEP indicates a desired response of the patient to the endovascular treatment.   
     
     
         20 . The method according to  claim 19 , wherein the N35 component of the ipsilateral and contralateral SEPs is recorded using the at least two electrodes located on the scalp of the patient. 
     
     
         21 . The method according to  claim 19 , wherein the P40 component of the ipsilateral and contralateral SEPs is recorded using the at least two electrodes located on the scape of the patient. 
     
     
         22 . The method according to  claim 19 , wherein both the N35 and P40 components of the ipsilateral and contralateral SEPs are recorded using the at least two electrodes located on the scalp of the patient. 
     
     
         23 . The method according to  claim 19 , wherein the apparatus is configured to record the ipsilateral and contralateral SEPs from C3′ and C4′ positions of the scalp of the patient using the at least two recording electrodes.