Detection of Cerebral Ischemia With Artificial Intelligence.

Study Overview
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Brief Summary
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In patients undergoing planned surgery for carotid tromendarterendectomy, a non-invasive device that registers heart rate variability is attached. Furthermore a non-invasive device that monitors cerebral oxygenation- near infrared spectroscopy as well as electroencephalography is also attached. At times when surgeons clamps the carotid artery, there will be a moment with controlled cerebral ischemia. This will be registered by the devices. The information obtained will be used to teach artificial intelligence what patterns are related to cerebral ischemia. The same procedure will be performed in patients undergoing ocklusive cerebral trombectomy, so the artificial intelligence will learn to recognize cerebral reperfusion.Blood samples will be drawn before and after cerebral ischemia may occur and will be analyzed for neurobiomarkers and cardiac biomarkers. To teach the algorithm patterns from anaesthesia and surgery in patients without pre existing neuronal injury, the same method will be applied to patients undergoing mixed abdominal surgery. This group will provide a better knowledge of neuro biomarker patterns during anesthesia and surgery.

Detailed Description
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The neurobiomarkers that will be analyzed for detection of cerebral ischemia is Glial Fibrillary Acidic Protein, Neurofilament light chains, S-100B, Neuron specific endolas, Total-tau. Cardiac biomarkers are troponin-t and NT-pro brain natriuretic peptide. Blood sampling will occur before anesthesia induction and 2 and 24 hours after surgery or plausible ischemia for patients undergoing surgery for carotid endarterectomy. For patients undergoing acute thrombectomy blood sampling will be performed as soon as possible after the patient has arrived to the hospital as well as 2 hours and 24 hours later. For patients undergoing mixed abdominal surgery, sampling will be done before anesthesia induction and 2 hours and 24 hours after surgery.

Official Title
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Detection of Cerebral Ischemia With Artificial Intelligence- Biomarkers as Indicators in Controlled Cerebral Ischemia and Reperfusion.

Conditions
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Ischemia, Cerebral, Ischemic Stroke, Artery Occlusion, Artery Carotid Stenosi, Anesthesia, Surgery

Intervention / Treatment
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* Other: No intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients planned for carotid surgery or trombectomy Giving informed consent to participate Exclusion Criteria: Patients that do not consent Patients with arrythmia or pacemaker

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cerebral ischemia<br>Patients undergoing planned surgery for carotid stenosis | Other: No intervention<br>* there will be NO intervention<br>|
| Reperfusion<br>Patients undergoing cerebral trombectomy. | Other: No intervention<br>* there will be NO intervention<br>|
| Anaesthesia and surgery<br>Patients without preexisting cerebral injury undergoing abdominal surgery and anaesthesia | Other: No intervention<br>* there will be NO intervention<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Heart Rate variability | Changes in Heart Rate Variability from baseline. | 2020-2030 | 
| Near infrared spectroscopy | Changes in Near Infrared spectroscopy from baseline. | 2020-2030 | 
| Electroencephalography | Changes in electroencephalography from baseline, more precisely the Power in alpha bands, beta band, delta bands and quotas between these. | 2020-2030 | 
| Biomarkers indicating cerebral ischemia in blood | Changes in levels of biomarkers in blood from baseline. Total tau, neurofilament light chains, glial fibrillary acidic protein, S-100, neuron specific endolas. | 2020-2030 | 
| Biomarkers indicating cardiac ischemia in blood | Changes in levels of biomarkers in blood from baseline. Troponin T | 2020-2030 |