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Background and Purpose-: Large artery occlusion (LAO) in ischemic stroke requires recognition and triage to an endovascular stroke treatment center. Noninvasive LAO detection is needed to improve triage.

Methods-: Prospective study to test whether noninvasive cerebral oximetry can detect anterior circulation LAO in acute stroke. Interhemispheric [DELTA]BrSO2 in LAO was compared with controls.

Results-: In LAO stroke, mean interhemispheric [DELTA]BrSO2 was -8.3 /-5.8% (n=19), compared with 0.4 /-5.8% in small artery stroke (n=17), 0.4 /-6.0% in hemorrhagic stroke (n=14), and 0.2 /-7.5% in subjects without stroke (n=19) (P<0.001). Endovascular stroke treatment reduced the [DELTA]BrSO2 in most LAO subjects (16/19). Discrimination of LAO at a -3% [DELTA]BrSO2 cut had 84% sensitivity and 70% specificity. Addition of the G-FAST clinical score (gaze-face-arm-speech- time) to the BrSO2 measure had 84% sensitivity and 90% specificity.

Conclusions-: Noninvasive cerebral oximetry may help detect LAO in ischemic stroke, particularly when combined with a simple clinical scoring system.

(C) 2018 American Heart Association, Inc.