Abstract
Background: Studies exploring on the relationship between blood pressure fluctuations and outcome in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) are limited. We aimed to investigate the influence of blood pressure variability (BPV) during the first 24 hours after IVT on neurological deterioration (END) and 3-month outcome after IVT in patients with symptomatic intracranial arterial stenosis or occlusion (SIASO).Methods: Clinical data from consecutive AIS patients with SIASO who received IVT were retrospectively analyzed. The hourly systolic BP of all patients were recorded during the first 24 hours following IVT. We calculated three syslolic BPV parameters including coefficient of variability (CV), standard deviation of mean BP (SD) and successive variation (SV). The SV was categorized into four grades based on quartiles. The END was defined as neurological deterioration with an increase in the National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within the first 72 hours after admission. Follow-ups was performed at 90 days after onset were performed, and favorable and poor outcome were defined as a modified Rankin Scale scores of ≤1 or ≥2, respectively.Results: A total of 110 patients were included, with a mean age of 62.0 ± 12.5 years. 86 patients (78.2%) were male. Twenty patients (18.2%) experienced END, and 37 patients (33.6%) had a favorable outcome. Compared with patients with in the poor outcome group, age ([64.8 ± 10.9] vs [56.7 ± 13.8]), NIHSS on admission (11.0 [7.0 -16.0] vs 6.0 [3.5 - 9.0]), SV ([14.5 ± 4.3] vs [11.8 ± 3.2]) and SD ([12.7 ± 3.8] vs [10.9 ± 3.3]) were lower in the favorable outcome group (all p < 0.05). No BPV parameters were associated with END. In the multivariable logistic regression analysis, compared with the lowest SV (SV<25% quartile), SV50%-75% (odds rato [OR] = 4.449, 95% confidence interval [CI] = 1.231-16.075, p = 0.023) and SV>75% (OR = 8.676, 95% CI = 1.892-39.775, p = 0.005) were significantly associated with poor outcome at 3 months. Conclusions: SV had a negative relationship with the 3-month outcome in AIS patients with SIASO treated with IVT, indicating that BPV may affect the outcome of AIS.
Relationship Between Blood Pressure and Stroke Recurrence in Patients With Intracranial Arterial Stenosis
