Abstract 177: The Association of Blood Pressure and Pretreatment Arterial Collaterals in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Beisi Jiang ◽  
Leonid Churilov ◽  
Lasheta Kanesan ◽  
Richard Dowling ◽  
Peter Mitchell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Time Delay ◽  
Acute Ischemic Stroke ◽  
Negative Binomial ◽  
Ct Perfusion ◽  
Arterial Occlusion ◽  
Negative Binomial Regression Model ◽  
Arterial Blood ◽  
Filling Time

Introduction: Leptomeningeal collaterals maintain arterial perfusion in acute arterial occlusion but may fluctuate subject to arterial blood pressure (ABP). We aim to investigate the relationship between ABP and collaterals as assessed by CT perfusion in acute ischemic stroke. Methods: We retrospectively analyzed acute anterior circulation ischemic stroke patients with CT perfusion from 2009 to 2014. Collateral status using relative filling time delay (rFTD) determined by time delay of collateral-derived contrast opacification within the Sylvian fissure, from 0 seconds to unlimited count. The data were analyzed by zero-inflated negative binomial regression model including an appropriate interaction examining in the model in terms of occlusion location and onset-to-CT time (OCT). Results: Two hundred and seventy patients were included. We found that increment of 10mm Hg in BP, the odds that a patient would have rFTD equal to 0 seconds increased by 27.9% in SBP (P=0.001), by 73.9% in diastolic blood pressure (DBP) (P<0.001) and by 68.5% in mean blood pressure (MBP) (P<0.001). For patients with rFTD not necessarily equal to 0 seconds, every 10mm Hg increase in BP, there was a 7% decrease in expected count of seconds for rFTD in SBP (P=0.002), 10% decrease for rFTD in DBP and 11% decrease for rFTD in MBP. The arterial occlusion location and OCT showed no significant interaction in the BP-rFTD relationship (P>0.05). Conclusions: In acute ischemic stroke, higher ABP is associated with improved leptomeningeal collaterals as identified by decreased rFTD.

scholarly journals Relative Filling Time Delay Based on CT Perfusion Source Imaging: A Simple Method to Predict Outcome in Acute Ischemic Stroke

2014 ◽  
Vol 35 (9) ◽  
pp. 1683-1687 ◽  
Author(s):  
W. Cao ◽  
B. C. V. Campbell ◽  
Q. Dong ◽  
S. M. Davis ◽  
B. Yan
Keyword(s):  
Ischemic Stroke ◽  
Time Delay ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Source Imaging ◽  
Simple Method ◽  
Filling Time

Abstract TMP89: Collaterals and Reperfusion Mediate Blood Pressure Changes in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David S Liebeskind ◽  
Graham W Woolf ◽  
Nerses Sanossian ◽  
Jason D Hinman ◽  
Radoslav Raychev ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Arterial Occlusion ◽  
Patient Specific ◽  
Pressure Data ◽  
Blood Pressure Data ◽  
Pressure Changes ◽  
Continuous Blood Pressure

Background: The pathophysiology and optimal management of blood pressure changes in acute ischemic stroke remain unknown. Blood pressure guidelines do not consider patient-specific or serial data on dynamic blood pressure readings. We investigated continuous blood pressure data during endovascular therapy for acute stroke to discern changes associated with collaterals, recanalization and reperfusion. Methods: Continuous monitoring blood pressure data was collected in consecutive cases of endovascular therapy for acute ischemic stroke due to ICA or proximal MCA occlusion. Angiography details were independently analyzed to document site of arterial occlusion, baseline collateral grade, time of device deployments, time of recanalization, time of final reperfusion, final AOL recanalization and final TICI reperfusion. Statistical analyses correlated instantaneous and serial blood pressure changes with these angiographic parameters. Results: 80 patients (median age 73 years; 33 women) were studied. Arterial lesions included 37 ICA and 41 proximal M1 MCA occlusions. Collateral grade prior to intervention included 2 ASITN grade 4, 26 grade 3, 23 grade 2, 6 grade 1 and 0 grade 0. oTICI2C reperfusion scores after thrombectomy included 2 TICI 3 (100%), 22 TICI 2C (90-99%), 25 TICI o2B (67-89%), 9 TICI m2B (50-66%), 19 TICI 2A (<50%) and 3 TICI 0/1. More robust collateral grade was associated with greater reperfusion scores (r=0.32, p=0.028). The change in blood pressure (ΔBP) from earliest BP to time of recanalization was mean 59% of ΔBP during the entire procedure. Better collaterals were associated with lower BP prior to recanalization (r=-0.377, p=0.012). Lower BP prior to recanalization was linked with greater TICI reperfusion (r=-0.242, p=0.050). Higher TICI reperfusion scores were also associated with a greater drop or ΔBP at the time of recanalization (r=0.269, p=0.031). AOL recanalization was not related to ΔBP. Conclusions: Collaterals and reperfusion, but not recanalization, mediate blood pressure changes in acute ischemic stroke. Prospective, precision medicine stroke studies should leverage patient-specific, real-time data on continuous blood pressure with imaging correlates to define BP goals of future in-hospital management.

Early Manipulation of Arterial Blood Pressure in Acute Ischemic Stroke (MAPAS): Results of a Randomized Controlled Trial

2018 ◽  
Vol 30 (2) ◽  
pp. 372-379 ◽  
Author(s):  
Luiz Antonio Nasi ◽  
Sheila Cristina Ouriques Martins ◽  
Miguel Gus ◽  
Gustavo Weiss ◽  
Andrea Garcia de Almeida ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trial ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Arterial Blood Pressure ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Arterial Blood

Abstract TP228: Continuous Non-invasive Blood Pressure versus Oscillometric Assessment in Acute Care After Intracerebral Hemorrhage, Intravenous Thrombolysis for Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Anne Koehler ◽  
Timo Siepmann ◽  
Simon Winzer ◽  
Eric Simon ◽  
Lars-Peder Pallesen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Positive Association ◽  
Diagnostic Agreement ◽  
Altman Plot ◽  
Bland Altman Plot ◽  
Arterial Blood

Introduction: Uncontrolled arterial hypertension increases the risk of intracerebral hemorrhage (ICH) in acute ischemic stroke (AIS) patients treated with intravenous tPA and may lead to hematoma progression in patients with primary ICH. While arterial blood pressure (aBP) is commonly monitored using intermittent oscillometric measurements, vascular unloading based assessment (VUA) allows noninvasive continuous (beat-to-beat) aBP monitoring with a finger cuff. We hypothesized that VUA monitoring is feasible in post thrombolysis and ICH care and shows diagnostic agreement with intermittent oscillometric assessment. Methods: Consecutive patients with either AIS receiving intravenous tPA or ICH were prospectively monitored for 24 hours following the index event using VUA monitoring and contralateral oscillometric aBP measurement every 30 minutes. Bland Altman Plot and linear regression were conducted to define diagnostic agreement. Results: We enrolled 24 AIS patients (10 males, aged 74±15 years, mean±standard deviation) receiving tPA and 24 ICH patients (16 males, aged 67±16 years). Mean systolic aBP assessed via VUA was higher and mean diastolic aBP was lower compared to oscillometric assessment in the entire population (systolic: 147 ± 23 mmHg vs. 144 ± 34, p=0.004; diastolic: 75 ± 14 mmHg vs. 77 ± 20 mmHg vs, p=0.004) There was a positive association between VUA and oscillometric aBP profiles (systolic aBP: coef. 0.24, p<0.005; diastolic aBP: coef. 0.31, p<0.005; figure). However, diagnostic agreement analysis was inconclusive. (Bland Altman Plot) Conclusions: Although VUA and oscillometric aBP profiles were positively associated in our study, diagnostic agreement between the techniques was not sufficient to recommend implementation of VUA in clinical practice. Figure

scholarly journals Cardiac Stroke Volume Index Is Associated With Early Neurological Improvement in Acute Ischemic Stroke Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Joseph Miller ◽  
Farhan Chaudhry ◽  
Sam Tirgari ◽  
Sean Calo ◽  
Ariel P. Walker ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Pilot Study ◽  
Stroke Volume ◽  
Acute Ischemic Stroke ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Neurological Improvement ◽  
Arterial Blood ◽  
Cardiac Stroke Volume

Early neurological improvement as assessed with the NIH stroke scale (NIHSS) at 24 h has been associated with improved long-term functional outcomes following acute ischemic stroke (AIS). Cardiac dysfunction is often present in AIS, but its association with outcomes is incompletely defined. We performed a pilot study to evaluate the association between non-invasively measured cardiac parameters and 24-h neurological improvement in prospectively enrolled patients with suspected AIS who presented within 12 h of symptom-onset and had an initial systolic blood pressure&gt;140 mm Hg. Patients receiving thrombolytic therapy or mechanical thrombectomy were excluded. Non-invasive pulse contour analysis was used to measure mean arterial blood pressure (MAP), cardiac stroke volume index (cSVI), cardiac output (CO) and cardiac index (CI). Transcranial Doppler recorded mean middle cerebral artery flow velocity (MFV). We defined a decrease of 4 NIHSS points or NIHSS ≤ 1 at 24-h as neurological improvement. Of 75 suspected, 38 had confirmed AIS and did not receive reperfusion therapy. Of these, 7/38 (18.4%) had neurological improvement over 24 h. MAP was greater in those without improvement (108, IQR 96–123 mm Hg) vs. those with (89, IQR 73–104 mm Hg). cSVI, CO, and MFV were similar between those without and with improvement: 37.4 (IQR 30.9–47.7) vs. 44.7 (IQR 42.3–55.3) ml/m2; 5.2 (IQR 4.2–6.6) vs. 5.3 (IQR 4.7–6.7) mL/min; and 39.9 (IQR 32.1–45.7) vs. 34.4 (IQR 27.1–49.2) cm/s, respectively. Multivariate analysis found MAP and cSVI as predictors for improvement (OR 0.93, 95%CI 0.85–0.98 and 1.14, 95%CI 1.03–1.31). In this pilot study, cSVI and MAP were associated with 24-h neurological improvement in AIS.

Predictive value of time-variant color-coded multiphase CT angiography (mCTA) regarding clinical outcome of acute ischemic stroke: in comparison with conventional mCTA and CT perfusion

2020 ◽  
pp. 028418512098177
Author(s):  
Yu Lin ◽  
Nannan Kang ◽  
Jianghe Kang ◽  
Shaomao Lv ◽  
Jinan Wang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Ct Perfusion ◽  
Roc Curves ◽  
Multivariate Logistic Regression Model ◽  
Infarct Core ◽  
Predictive Values ◽  
Significant Difference ◽  
Core Volume

Background Color-coded multiphase computed tomography angiography (mCTA) can provide time-variant blood flow information of collateral circulation for acute ischemic stroke (AIS). Purpose To compare the predictive values of color-coded mCTA, conventional mCTA, and CT perfusion (CTP) for the clinical outcomes of patients with AIS. Material and Methods Consecutive patients with anterior circulation AIS were retrospectively reviewed at our center. Baseline collateral scores of color-coded mCTA and conventional mCTA were assessed by a 6-point scale. The reliabilities between junior and senior observers were assessed by weighted Kappa coefficients. Receiver operating characteristic (ROC) curves and multivariate logistic regression model were applied to evaluate the predictive capabilities of color-coded mCTA and conventional mCTA scores, and CTP parameters (hypoperfusion and infarct core volume) for a favorable outcome of AIS. Results A total of 138 patients (including 70 cases of good outcomes) were included in our study. Patients with favorable prognoses were correlated with better collateral circulations on both color-coded and conventional mCTA, and smaller hypoperfusion and infarct core volume (all P < 0.05) on CTP. ROC curves revealed no significant difference between the predictive capability of color-coded and conventional mCTA ( P = 0.427). The predictive value of CTP parameters tended to be inferior to that of color-coded mCTA score (all P < 0.001). Both junior and senior observers had consistently excellent performances (κ = 0.89) when analyzing color-coded mCTA maps. Conclusion Color-coded mCTA provides prognostic information of patients with AIS equivalent to or better than that of conventional mCTA and CTP. Junior radiologists can reach high diagnostic accuracy when interpreting color-coded mCTA images.

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