Work

Feasibility of sidestream darkfield imaging of the sublingual and conjunctival microcirculation in aneurysmal subarachnoid haemorrhage patients: A technical report

Year: 2025

Type: article

Abstract: OBJECTIVE: Microcirculatory changes contribute to delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), but bedside assessment remains challenging. Sidestream darkfield imaging (SDF) enables direct visualization but may be difficult in critically ill patients. The objective was to evaluate the feasibility of repeated sublingual and conjunctival SDF imaging in aSAH patients and to compare microcirculatory changes at both sites. METHODS: SDF imaging was performed sublingually and conjunctivally at six timepoints after aSAH. Feasibility was assessed by completion rate, patient experience, and acquisition time. Logistic mixed models identified factors influencing completion and microvascular outcomes. Agreement between sites was assessed with Bland-Altman plot and Spearman correlation. RESULTS: Thirty patients were included. Sublingual and conjunctival imaging completion rates were 89% and 70% respectively, with the latter declining over time. Positive patient experience increased success (OR 16, 95% 3.46-74.17), while longer acquisition time reduced success (OR 0.89, 95% CI 0.80-0.98). Discomfort was the main cause of conjunctival imaging failure. Sublingual and conjunctival parameters showed distinct trajectories during follow-up. CONCLUSION: Sublingual SDF imaging is a feasible, well-tolerated method for serial microcirculatory assessment in aSAH patients. Conjunctival imaging is less tolerated and may be less suitable for repeated measurements. Microcirculatory changes differ between sites and cannot be used interchangeably.

Source: Journal of Stroke and Cerebrovascular Diseases

DOI: 10.1016/j.jstrokecerebrovasdis.2025.108498