RELATIONSHIP OF SYSTOLIC BLOOD PRESSURE DURING 24 HOURS AFTER THROMBOLYSIS TO CLINICAL OUTCOME IN PATIENTS WITH ACUTE ISCHEMIC STROKE

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.

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SYSTOLIC BLOOD PRESSURE VARIABILITY DURING MECHANICAL THROMBECTOMY IS ASSOCIATED WITH EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE PATIENTS

10.26226/morressier.58e389aed462b80292385662 ◽

2017 ◽

Author(s):

João Pedro Marto

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Systolic Blood Pressure ◽

Acute Ischemic Stroke ◽

Blood Pressure Variability ◽

Mechanical Thrombectomy ◽

Neurological Deterioration ◽

Stroke Patients ◽

Early Neurological Deterioration ◽

Systolic Blood Pressure Variability

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

Current Cardiology Reports ◽

10.1007/s11886-021-01497-0 ◽

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.

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

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017963 ◽

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.

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

Journal of the American Heart Association ◽

10.1161/jaha.119.014399 ◽

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

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The Association of Blood Pressure and Collateral Circulation in Hyperacute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Cerebrovascular Diseases ◽

10.1159/000371339 ◽

2015 ◽

Vol 39 (2) ◽

pp. 130-137 ◽

Cited By ~ 17

Author(s):

Harri Rusanen ◽

Jukka T. Saarinen ◽

Niko Sillanpää

Keyword(s):

Blood Pressure ◽

Multivariate Analysis ◽

Ischemic Stroke ◽

Mean Arterial Pressure ◽

Clinical Outcome ◽

Thrombolytic Therapy ◽

Systolic Blood Pressure ◽

Pulse Pressure ◽

Collateral Circulation ◽

Stroke Patients

Background: The integrity of collateral circulation is a major prognostic factor in ischemic stroke. Patients with good collateral status have larger penumbra and respond better to intravenous thrombolytic therapy. High systolic blood pressure is linked with worse clinical outcome in patients with acute ischemic stroke treated with intravenous thrombolytic therapy. We studied the effect of different blood pressure parameters on leptomeningeal collateral circulation in patients treated with intravenous thrombolytic therapy (<3 h) in a retrospective cohort. Methods: Anterior circulation thrombus was detected with computed tomography angiography and blood pressure was measured prior to intravenous thrombolytic therapy in 104 patients. Baseline clinical and imaging information were collected. Group comparisons were performed; Collateral Score (CS) was assessed and entered into logistic regression analysis. Results: Fifty-eight patients out of 104 displayed good collateral filling (CS ≥2). Poor CS was associated with more severe strokes according to National Institutes of Health Stroke Scale (NIHSS) at arrival (16 vs. 11, p = 0.005) and at 24 h (15 vs. 3, p < 0.001) after the treatment. Good CS was associated with higher systolic blood pressure (p = 0.03), but not with diastolic blood pressure (p = 0.26), pulse pressure (p = 0.20) or mean arterial pressure (p = 0.07). Good CS was associated with better Alberta Stroke Program Early CT Score (ASPECTS) in 24 h follow-up imaging (p < 0.001) and favorable clinical outcome at three months (mRS ≤2, p < 0.001). Median CS was the highest (CS = 3) when systolic blood pressure was between 170 and 190 mm Hg (p = 0.03). There was no significant difference in the number of patients with good (n = 11) and poor (n = 12) CS who received intravenous antihypertensive medication (p = 0.39) before or during the thrombolytic therapy. In multivariate analysis age (p = 0.02, OR 0.957 per year, 95% CI 0.92-0.99), time from the onset of symptoms to treatment (p = 0.005, OR 1.03 per minute, 95% CI 1.01-1.05), distal clot location (p = 0.02, OR 3.52, 95% CI 1.19-10.35) and systolic blood pressure (p = 0.04, OR 1.03 per unit mm Hg, 95% CI 1.00-1.05) predicted good CS. Higher systolic blood pressure (p = 0.049, OR 0.96 per unit mm Hg, 95% CI 0.93-1.00) and pulse pressure (p = 0.005, OR 0.94 per unit mm Hg, 95% CI 0.90-0.98) predicted unfavorable clinical outcome at three months in multivariate analysis. Conclusion: Moderately elevated systolic blood pressure is associated with good collateral circulation in patients treated with intravenous thrombolytic therapy. However, there is an inverse association of systolic blood pressure with the three-month clinical outcome. Diastolic blood pressure, mean arterial pressure and pulse pressure are not statistically and significantly associated with collateral status.

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