scholarly journals Predictors for the extent of pial collateral recruitment in acute ischemic stroke

2020 ◽  
Vol 33 (2) ◽  
pp. 98-104 ◽  
Author(s):  
Gregory A Christoforidis ◽  
Niloufar Saadat ◽  
Marinos Kontzialis ◽  
Christopher J Karakasis ◽  
Andrew P Slivka
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diastolic Blood Pressure ◽  
Clinical Information ◽  
Symptom Duration ◽  
Collateral Flow ◽  
Variable Degree ◽  
Segment Versus ◽  
Antegrade Flow

Background Pial arterioles can provide a variable degree of collateral flow to ischemic vascular territories during acute ischemic stroke. This study sought to identify predictive factors of the degree of pial collateral recruitment in acute ischemic stroke. Methods Clinical information and arteriograms from 62 consecutive patients with stroke due to either middle cerebral artery (MCA) M1 segment or internal carotid artery (ICA) terminus occlusion within 6 h following symptom onset were retrospectively reviewed. Pial collaterals were defined based on the extent of reconstitution of the MCA territory. Patients with slow antegrade flow distal to the occlusion site were excluded and no anesthetics were used prior or during angiography. Results were analyzed using multivariate nominal logistic regression. Results Better pial collateral recruitment was associated with proximal MCA versus ICA terminus occlusion ( p = 0.005; odds ratio (OR) = 9.3; 95% confidence interval (CI), 2.16–53.3), lower presenting National Institutes of Health Stroke Scale Score (NIHSSS) ( p = 0.023; OR = 6.51; 95% CI, 1.49–41.7), and lower diastolic blood pressure ( p = 0.0411; OR = 5.05; 95% CI, 1.20–29.2). Age, gender, symptom duration, diabetes, laterality, systolic blood pressure, glucose level, hematocrit, platelet level, and white blood cell count at presentation were not found to have a statistically significant association with pial collateral recruitment. Conclusions Extent of pial collateral recruitment is strongly associated with the occlusion site (MCA M1 segment versus ICA terminus) and less strongly associated with presenting NIHSSS and diastolic blood pressure.

scholarly journals Impact of Early Blood Pressure Lowering in Patients Presenting with Acute Ischemic Stroke

2021 ◽  
Vol 23 (6) ◽  
Author(s):  
A. Maud ◽  
G. J. Rodriguez ◽  
A. Vellipuram ◽  
F. Sheriff ◽  
M. Ghatali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Negative Impact ◽  
Systemic Blood Pressure ◽  
Hemodynamic Response ◽  
Collateral Flow ◽  
Early Management ◽  
Ischemic Tissue

Abstract Purpose of Review In this review article we will discuss the acute hypertensive response in the context of acute ischemic stroke and present the latest evidence-based concepts of the significance and management of the hemodynamic response in acute ischemic stroke. Recent Findings Acute hypertensive response is considered a common hemodynamic physiologic response in the early setting of an acute ischemic stroke. The significance of the acute hypertensive response is not entirely well understood. However, in certain types of acute ischemic strokes, the systemic elevation of the blood pressure helps to maintain the collateral blood flow in the penumbral ischemic tissue. The magnitude of the elevation of the systemic blood pressure that contributes to the maintenance of the collateral flow is not well established. The overcorrection of this physiologic hemodynamic response before an effective vessel recanalization takes place can carry a negative impact in the final clinical outcome. The significance of the persistence of the acute hypertensive response after an effective vessel recanalization is poorly understood, and it may negatively affect the final outcome due to reperfusion injury. Summary Acute hypertensive response is considered a common hemodynamic reaction of the cardiovascular system in the context of an acute ischemic stroke. The reaction is particularly common in acute brain embolic occlusion of large intracranial vessels. Its early management before, during, and immediately after arterial reperfusion has a repercussion in the final fate of the ischemic tissue and the clinical outcome.

scholarly journals Increased blood pressure variability after acute ischemic stroke increases the risk of death: A secondary analysis of the Virtual International Stroke Trial Archive

2019 ◽  
Vol 8 ◽  
pp. 204800401985649 ◽  
Author(s):  
Adam de Havenon ◽  
Greg Stoddard ◽  
Monica Saini ◽  
Ka-Ho Wong ◽  
David Tirschwell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Acute Ischemic Stroke ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Risk Of Death ◽  
Study Enrollment ◽  
Systolic Blood Pressure Variability ◽  
Stroke Trial

Background Despite promising epidemiological data, it remains unclear if increased blood pressure variability is associated with death after acute ischemic stroke. Our objective was to examine this association in a large cohort of acute ischemic stroke patients. Methods We conducted a retrospective analysis of anonymized, pooled, participant data from the Virtual International Stroke Trial Archive. We included patients with a 90-day modified Rankin Scale and blood pressure readings in the 24 h after study enrollment. The exposure was blood pressure variability during the day after study enrollment, calculated for the systolic and diastolic blood pressure using six statistical methodologies. The primary outcome was death within 90 days of stroke onset. Results Our cohort comprised 1891 patients of whom 277 (14.7%) died within 90 days. All indices of blood pressure variability were higher in patients who died, but the difference was more pronounced for systolic than diastolic blood pressure variability (systolic standard deviation for alive versus dead patients = 13.4 versus 15.9 mmHg, p < 0.001). Similar results were found in logistic regression models fit to the outcome of death, but only systolic blood pressure variability remained significant in adjusted models (Odds Ratio for death when comparing highest to lowest tercile of systolic blood pressure variability = 1.41–1.89, p < 0.03 for all). Conclusions and relevance: These results reinforce prior studies that found increased blood pressure variability is associated with worse neurologic outcome after stroke. These data should help guide research on blood pressure variability after stroke and advocate for the inclusion of death as a clinical outcome in future studies that therapeutically reduce blood pressure variability.

scholarly journals Frequency, Determinants, and Outcomes of Emboli to Distal and New Territories Related to Mechanical Thrombectomy for Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Gregory J. Wong ◽  
Bryan Yoo ◽  
David Liebeskind ◽  
Humain Baharvahdat ◽  
Jeffrey Gornbein ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Diastolic Blood Pressure ◽  
Odds Ratio ◽  
Resonance Imaging ◽  
Stroke Patients

Background and Purpose: Clot fragmentation and distal embolization during endovascular thrombectomy for acute ischemic stroke may produce emboli downstream of the target occlusion or in previously uninvolved territories. Susceptibility-weighted magnetic resonance imaging can identify both emboli to distal territories (EDT) and new territories (ENT) as new susceptibility vessel signs (SVS). Diffusion-weighted imaging (DWI) can identify infarcts in new territories (INT). Methods: We studied consecutive acute ischemic stroke patients undergoing magnetic resonance imaging before and after thrombectomy. Frequency, predictors, and outcomes of EDT and ENT detected on gradient-recalled echo imaging (EDT-SVS and ENT-SVS) and INT detected on DWI (INT-DWI) were analyzed. Results: Among 50 thrombectomy-treated acute ischemic stroke patients meeting study criteria, mean age was 70 (±16) years, 44% were women, and presenting National Institutes of Health Stroke Scale score 15 (interquartile range, 8–19). Overall, 21 of 50 (42%) patients showed periprocedural embolic events, including 10 of 50 (20%) with new EDT-SVS, 10 of 50 (20%) with INT-DWI, and 1 of 50 (2%) with both. No patient showed ENT-SVS. On multivariate analysis, model-selected predictors of EDT-SVS were lower initial diastolic blood pressure (odds ratio, 1.09 [95% CI, 1.02–1.16]), alteplase pretreatment (odds ratio, 5.54 [95% CI, 0.94–32.49]), and atrial fibrillation (odds ratio, 7.38 [95% CI, 1.02–53.32]). Classification tree analysis identified pretreatment target occlusion SVS as an additional predictor. On univariate analysis, INT-DWI was less common with internal carotid artery (5%), intermediate with middle cerebral artery (25%), and highest with vertebrobasilar (57%) target occlusions ( P =0.02). EDT-SVS was not associated with imaging/functional outcomes, but INT-DWI was associated with reduced radiological hemorrhagic transformation (0% versus 54%; P <0.01). Conclusions: Among acute ischemic stroke patients treated with thrombectomy, imaging evidence of distal emboli, including EDT-SVS beyond the target occlusion and INT-DWI in novel territories, occur in about 2 in every 5 cases. Predictors of EDT-SVS are pretreatment intravenous fibrinolysis, potentially disrupting thrombus structural integrity; atrial fibrillation, possibly reflecting larger target thrombus burden; lower diastolic blood pressure, suggestive of impaired embolic washout; and pretreatment target occlusion SVS sign, indicating erythrocyte-rich, friable target thrombus.

scholarly journals A Novel FAND Nomogram to Predict the Risk of Hospital-Acquired Pneumonia after Acute Ischemic Stroke with Mechanical Thrombectomy

2019 ◽  
Author(s):  
Belynda Owoya Ochete ◽  
Linda Nyame ◽  
Xiang Li ◽  
Yang Zou ◽  
XueMei Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diastolic Blood Pressure ◽  
Patient Outcomes ◽  
Mechanical Thrombectomy ◽  
Preventive Measure ◽  
Predictive Tool ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract Background: The timely prediction in the risk of Hospital-Acquired Pneumonia（HAP）in Acute Ischemic stroke (AIS) patients after Mechanical thrombectomy (MT) treatment is of high priority, given the rise in AIS mortality as a result. Although prior extensive research has been conducted in HAP preventive management and therapeutics, ischemic stroke patients are still at serious risk of contracting In-hospital pneumonia infections following certain medical procedures like Mechanical thrombectomy, a care standard for AIS patients. The predictive accuracy of patients with higher infection risk and adjusting therapeutic strategies accordingly will not only provide an enhanced preventive measure perspective but also significantly improve patient outcomes. Hence, our study was aimed at the validation and development of a novel predictive tool for risk stratification and individualized predictions of HAP occurrence in AIS patients after MT therapy. Method: A multicenter retrospective study was executed with 405 AIS patients after undergoing MT treatment and admitted to the three Chinese stroke units. The major measure of outcome was to estimate the risk of HAP after MT through the integration of the following four predictors FBG, Age, NHISS, and Diastolic blood pressure (FAND) into a nomogram. Assessed on the multivariate logistic model, a nomogram was constructed, using the area under the receiver-operating characteristic curve to evaluate the discriminative performance and the Hosmer–Lemeshow test for risk prediction model calibration. Results: Age(OR:1039; 95%Cl 1.017-1.062; p=0.001), NIHSS(National Institutes of Health Stroke Scale) score on admission(OR:1.066; 95%Cl: 1.030-1.103); p< 0.0001), diastolic blood pressure(OR 1.023; 95% Cl 1.006-1.040: p=0.008), Fasting blood glucose(OR 1.1444; 95% Cl 1.029-1.271; p=0.013) remained independent predictors of HAP integrated into the FAND nomogram after AIS Chinese patients received MT treatment. The Hosmer-Lemeshow goodness-of fit-test expressed good calibration(p-value: 0.496) and Area under the curve of 0.737 was exhibited for functional impairment prediction. Conclusion: The FAND nomogram is a novel prognostic model developed and validated in Chinese AIS patients after MT treatment may aid in preventive measure strategies and predict poor patient outcomes.

scholarly journals Relationship between Blood Pressure and Outcomes in Acute Ischemic Stroke Patients Administered Lytic Medication in the TIMS-China Study

PLoS ONE ◽  
2016 ◽  
Vol 11 (2) ◽  
pp. e0144260 ◽  
Author(s):  
Wei Wu ◽  
Xiaochuan Huo ◽  
Xingquan Zhao ◽  
Xiaoling Liao ◽  
Chunjuan Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
China Study

Abstract TP476: White Matter Hyperintensity Burden is Associated With Poor Collateral Flow and Worse Outcomes in an Acute Ischemic Stroke Cohort

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Rami-James Assadi ◽  
Hongyu An ◽  
Yasheng Chen ◽  
Andria Ford ◽  
Jin-Moo Lee
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Pearson Correlation ◽  
Stroke Onset ◽  
White Matter Hyperintensity ◽  
Flow Index ◽  
Acute Ischemia ◽  
Collateral Flow ◽  
Core Volume

Introduction: White matter hyperintensity volume (WMHv), a quantitative neuroimaging biomarker of cerebral small vessel disease (CSVD), is associated worse outcomes after ischemic stroke. In this study, we hypothesized that worse outcomes in CSVD patients were due to poor collateral flow during acute ischemia. Methods: 47 patients with acute ischemic stroke (AIS) were prospectively enrolled in this study. Serial MRIs were performed at 3 hours and 30 days after stroke onset. 3-hour FLAIR images were used to determine WMHv, after manually delineating lesions with MIPAV. An index of collateral flow (delayed perfusion to the penumbra) was determined by subtracting core volume (volume of tissue with ADC<600) from the volume of brain tissue with Tmax>2. Patient’s NIHSS was scored at 3 hours and 30 days after stroke onset and the difference was calculated (ΔNIHSS). Log-transformed WMHv was correlated to ΔNIHSS and the collateral flow index, using Pearson correlation. Results: Mean age = 63.9 years (SD 13.5); 37% female; median 3-hour NIHSS = 13 (IQR 6.5-20); median change in NIHSS between 3h and 30d = 4 (IQR: 0-7); median core volume = 13cm3 (IQR 4.3-35.6); median WMHv = 1.257cm3 (IQR 641-3595). WMHv was associated with reduced improvement in ΔNIHSS (R=-0.42, ρ=0.005). Furthermore, WMHv demonstrated a trend for association with poor collateral flow (R=-0.28, ρ=0.062). In this dataset, we will explore the relationship between WMHv and other tissue-based metrics of collateral flow, including the hypoperfusion intensity ratio (HIR) and the cerebral blood volume ratio (rCBV). Conclusions: Our study confirms that patients with CSVD have worse outcomes after AIS. The data also raise the possibility that these worse outcomes in CSVD patients may be mediated by compromised collateral flow in the setting of acute ischemia.

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