Abstract WP162: Systolic Blood Pressure Night-dipping Influences Functional Recovery in Acute Ischemic Stroke With Severe Cervicocephalic Atherosclerotic Stenosis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Xin Ma ◽  
Qi Kong ◽  
Guiling Wan ◽  
Sufang Xue ◽  
Yi Ren
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Functional Recovery ◽  
Blood Pressure Monitoring ◽  
Atherosclerotic Stenosis ◽  
Traditional Risk Factors ◽  
Relationship Of

Background and Purpose: Systolic blood pressure falling by 10-20% of daytime values during the night constitutes a physiological night-dipping pattern. Blunted (<10%) systolic blood pressure night-dipping (SBPN) is a risk factor of acute ischemic stroke (AIS), but the prognostic value of SBPN for patients with AIS remains unclear. Severe (≥70%) cervicocephalic atherosclerotic stenosis (SCAS), different from the mild or moderate stenosis, renders the cerebral perfusion more vulnerable to variations of blood pressure is prevalent in AIS, and may consequently change the relationship of SBPN with AIS outcomes. We sought to examine the association between SBPN and AIS functional recovery, respectively in patients with and without SCAS. Methods: Patients with AIS within 6 days were consecutively enrolled and divided into SCAS group and non-SCAS group according to whether there was SCAS on CT angiography. SBPN was evaluated by the night-to-day dipping percentage using 24-hour ambulatory blood pressure monitoring on the 6 th day after the symptom onset. A reduction in modified Rankin scale score (mRS) after 3 months compared to mRS at admission was defined as functional recovery. Results: Among 247 AIS patients, 194 (78.5%) had blunted SBPN, and the mean SBPN percentage was 3.12% ± 7.83% (minimal: -24%, median: 3%, maximal: 22%). AIS patients with blunted SBPN were less likely to have the functional recovery than those with normal SBPN (63.9% vs. 81.1%, p=0.018). There was significant interaction between the SBPN percentage and the presence of SCAS for predicting the functional recovery (p=0.026). In AIS patients with SCAS (n=146), rather than in those without (n=101), the SBPN percentage could serve as an indicator of 3-month functional recovery independently of age, sex, National Institute of Health stroke scale score at admission and traditional risk factors (adjusted odd ratio=1.06 for per percent increase of SBPN, 95% confidential interval: 1.01-1.11). Conclusions: Blunted SBPN was frequent among patients with AIS. Adverse effects exerted by lower SBPN on AIS functional recovery were more considerable in patients with SCAS. For AIS patients with SCAS, evaluating SBPN was important to assess their prognosis.

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.

scholarly journals Normal Systolic Blood Pressure at Presentation With Acute Ischemic Stroke Predicts Cardioembolic Etiology

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Margaret Moores ◽  
Vignan Yogendrakumar ◽  
Olena Bereznyakova ◽  
Walid Alesefir ◽  
Hailey Pettem ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Acute Ischemic Stroke

scholarly journals One-Year Systolic Blood Pressure Trajectory After Acute Ischemic Stroke

2021 ◽  
Author(s):  
Keon-Joo Lee ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Joon-Tae Kim ◽  
Kang Ho Choi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Acute Ischemic Stroke ◽  
Adverse Outcomes ◽  
Stroke Onset ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
One Year

Abstract Although the effect of blood pressure on post-stroke outcome is well-recognized, the long-term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not yet been fully elucidated. From a multicenter prospective registry of acute ischemic stroke patients, 5,514 patients with measurements of systolic blood pressure (SBP) at more than 2 of 7 prespecified time-points, up to 1-year after stroke onset, were analyzed. Outcome measures, a composite of stroke recurrence, myocardial infarction and mortality, and each stroke recurrence and mortality, were prospectively collected up to 1-year after stroke onset. The study subjects were categorized into 4 groups according to their SBP trajectories: Low (27.0%), Moderate (59.5%), Persistently high (1.2%), and Slowly dropping (12.4%). After adjustments for pre-determined covariates, the Slowly dropping SBP Group was at higher risk of the composite outcome (hazard ratio, 1.32; 95% confidence interval, 1.05‒1.65), and mortality (1.35; 1.03‒1.78) compared to the Moderate SBP Group. Four main 1-year longitudinal SBP trajectories were identified after acute ischemic stroke. One trajectory, slowly dropping SBP, was particularly prone to adverse outcomes after stroke. These findings provide possible leads for future investigations of SBP control targets after stroke.

Abstract 1122‐000166: Stroke Severity Factors in patients with Acute Ischemic Stroke and Heart Failure Stratifying by Age

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Camron K Edrissi ◽  
Carolyn Sanders ◽  
Chase Rathfoot ◽  
Krista Knisely ◽  
Thomas Nathaniel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Acute Ischemic Stroke ◽  
Heart Valve ◽  
Prosthetic Heart Valve ◽  
Stroke Severity ◽  
Factors Associated ◽  
Elevated Systolic Blood Pressure

Introduction : The goal of this study is to investigate the clinical risk factors associated with acute ischemic stroke (AIS) severity in heart failure (HF) patients above and below 70 years old using the National Institutes of Health Stroke Scale (NIHSS) as a measure for stroke severity. Methods : This study uses retrospective analysis of AIS patients who were previously diagnosed with HF. Data was collected from a regional stroke center from January 2010 to June 2016. Multivariate logistic regression identified the factors associated with stroke severity, with a NIHSS score <7 indicating low severity and a score ≥7 indicating high severity. These results were stratified by patient ages of < and ≥70 years old. Results : A total of 590 patients presented with AIS and a previous diagnosis of HF. The AIS‐HF population contained 223 patients that were <70 years old and 367 that were ≥70 years old. In the AIS‐HF population, patients who were ≥70 years old who presented with coronary artery stenosis (CAS) (OR = 8.592, 95% CI, 2.123‐34.772, P <0.003), prosthetic heart valve (OR = 22.028, 95% CI, 1.454‐333.746, P <0.026), elevated systolic blood pressure (OR = 1.014, 95% CI, 1.002‐1.026, P < 0.024), and tissue plasminogen activator (tPA) administration (OR = 4.002, 95% CI, 1.912‐8.377, P < 0.001) were associated with a higher NIHSS. Alternatively, those that presented with gender differences (OR = 0.466, 95% CI, 0.235‐0.925, P < 0.029), family history of stroke (OR = 0.084, 95% CI, 0.010‐0.726, P < 0.024), obesity (OR = 0.493, 95% CI, 0.261‐0.930, P < 0.029), smoking (OR = 0.253, 95% CI, 0.063‐1.022, P < 0.054), serum creatinine (OR = 0.629, 95% CI, 0.399‐0.992, P < 0.046), INR level (OR = 0.457, 95% CI, 0.191‐1.094, P < 0.079) were associated with a lower NIHSS. Conclusions : The data revealed a variety of components that may affect Stroke Severity in AIS patients with HF. The associated factors exhibited significant differences between distinct age groups. AIS‐HF patients ≥70 years old who presented with CAS, prosthetic heart valve, elevated systolic blood pressure, and received tPA administration were associated with higher stroke severity (≥7 NIHSS) compared to <70 years old group. Identifying more concrete clinical and demographic associations may aid in the identification and evidence‐based management of patients who suffer from AIS.

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