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

Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a meta-analysis

2021 ◽  
pp. neurintsurg-2021-017963
Author(s):  
Gang Deng ◽  
Jun Xiao ◽  
Haihan Yu ◽  
Man Chen ◽  
Ke Shang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Serum Glucose ◽  
Female Sex ◽  
Symptomatic Intracerebral Hemorrhage

BackgroundDespite successful recanalization after endovascular treatment, many patients with acute ischemic stroke due to large vessel occlusion still show functional dependence, namely futile recanalization.MethodsPubMed and Embase were searched up to April 30, 2021. Studies that reported risk factors for futile recanalization following endovascular treatment of acute ischemic stroke were included. The mean difference (MD) or odds ratio (OR) and 95% confidence interval (95% CI) of each study were pooled for a meta-analysis.ResultsTwelve studies enrolling 2138 patients were included. The pooled analysis showed that age (MD 5.81, 95% CI 4.16 to 7.46), female sex (OR 1.40, 95% CI 1.16 to 1.68), National Institutes of Health Stroke Scale (NIHSS) score (MD 4.22, 95% CI 3.38 to 5.07), Alberta Stroke Program Early CT Score (ASPECTS) (MD −0.71, 95% CI −1.23 to –0.19), hypertension (OR 1.73, 95% CI 1.43 to 2.09), diabetes (OR 1.78, 95% CI 1.41 to 2.24), atrial fibrillation (OR 1.24, 95% CI 1.01 to 1.51), admission systolic blood pressure (MD 4.98, 95% CI 1.87 to 8.09), serum glucose (MD 0.59, 95% CI 0.37 to 0.81), internal carotid artery occlusion (OR 1.85, 95% CI 1.17 to 2.95), pre-treatment intravenous thrombolysis (OR 0.67, 95% CI 0.55 to 0.83), onset-to-puncture time (MD 16.92, 95% CI 6.52 to 27.31), puncture-to-recanalization time (MD 12.37, 95% CI 7.96 to 16.79), and post-treatment symptomatic intracerebral hemorrhage (OR 6.09, 95% CI 3.18 to 11.68) were significantly associated with futile recanalization.ConclusionThis study identified female sex, comorbidities, admission systolic blood pressure, serum glucose, occlusion site, non-bridging therapy, and post-procedural complication as predictors of futile recanalization, and also confirmed previously reported factors. Further large-scale prospective studies are needed.

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

scholarly journals PREDIKTOR SYMPTOMATIC INTRACEREBRAL HEMORRHAGE PASCATROMBOLISIS INTRAVENA PADA STROKE ISKEMIK AKUT

2018 ◽  
Vol 35 (3) ◽  
Author(s):  
Al Rasyid ◽  
Salim Harris ◽  
Mohammad Kurniawan ◽  
Rakhmad Hidayat ◽  
Taufik Mesiano
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Intravenous Thrombolysis ◽  
Definitive Treatment ◽  
Stroke Patients ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Thrombolysis ◽  
Withholding Therapy ◽  
Diabetes Melitus

PREDICTORS OF SYMPTOMATIC INTRACEREBRAL HEMORRHAGE FOLLOWING INTRAVENOUS THROMBOLYSIS IN ACUTE ISCHEMIC STROKEABSTRACTDespite its effectiveness, the percentage of ischemic stroke patients who received definitive treatment, thrombolysis, never went above 10%, due to one of the reason is the occurrence of severe, post-therapeutic complications, such as symptomatic intracerebral hemorrhage (sICH). Several factors contribute to sICH occurrence are age, severity of stroke, early changes of ischemic sign, hyperglycemia, blood pressure, antiplatelet use and its interval. Patients with highest risk of sICH has been shown to have the greatest benefits from thrombolysis among other subgroup patients, therefore withholding therapy is not a choice. Compliance to the stroke’s guidelines could reduce the risk of complications as well as boost effectiveness of treatment.Keywords: Safety predictors, acute ischemic stroke, thrombolysis, sICH ABSTRAK Walau terbukti efektif, persentase pasien yang dapat dilakukan tindakan definitif stroke iskemik akut berupa trombolisis  tidak  pernah  mencapai  angka  10%,  salah  satunya  disebabkan  pertimbangan  terhadap  komplikasi  berat, seperti symptomatic intracerebral hemorrhage (sICH). Beberapa faktor yang berpengaruh terhadap kejadian sICH antara lain usia, derajat stroke, perubahan tanda iskemik dini, hiperglikemia dan diabetes melitus, tekanan darah, penggunaan antiplatelet, serta waktu pemberian. Pasien dengan risiko sICH tertinggi memiliki keuntungan terbesar dari trombolisis sehingga menunda tindakan bukanlah suatu opsi. Kepatuhan terhadap panduan tindakan dapat mengurangi angka kejadian komplikasi berat.Kata kunci: Prediktor keamanan, stroke iskemik akut, trombolisis, sICH

Blood pressure excursions in acute ischemic stroke patients treated with intravenous thrombolysis

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Georgios Tsivgoulis ◽  
Aristeidis H. Katsanos ◽  
Pitchaiah Mandava ◽  
Martin Köhrmann ◽  
Lauri Soinne ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Stroke Patients

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.

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