A Prospective Study to Investigate Controlling Blood Pressure Under Transcranial Doppler After Endovascular Treatment in Patients With Occlusion of Anterior Circulation

Tao, Chunrong; Xu, Pengfei; Yao, Yang; Zhu, Yajuan; Li, Rui; Li, Jie; Luo, Wenwu; Hu, Wei

doi:10.3389/fneur.2021.735758

Cited by 7 publications

(3 citation statements)

References 31 publications

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“…42 Furthermore, evidence is scarce regarding BPV management as well. Radiological measures, including the assessment of recanalization status post-EVT, but also by evaluating dynamic brain autoregulation in real time though near-infrared spectroscopy-derived tissue oxygenation 43 or transcranial doppler 44 may also be used to guide BP management within targeted and tighter ranges, thus avoiding increased systolic BPV. Regarding antihypertensive treatment, calcium channel blockers and non-loop diuretic drugs either alone or as additives to other antihypertensive agents have been shown to significantly, albeit modestly, reduce BPV, whereas b-blockers have been associated with elevated BPV.…”

Section: Discussionmentioning

confidence: 99%

Association between blood pressure variability and outcomes after endovascular thrombectomy for acute ischemic stroke: An individual patient data meta-analysis

Palaiodimou,

Joundi,

Katsanos

et al. 2023

European Stroke Journal

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Introduction: Data on the association between blood pressure variability (BPV) after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) and outcomes are limited. We sought to identify whether BPV within the first 24 hours post EVT was associated with key stroke outcomes. Methods: We combined individual patient-data from five studies among AIS-patients who underwent EVT, that provided individual BP measurements after the end of the procedure. BPV was estimated as either systolic-BP (SBP) standard deviation (SD) or coefficient of variation (CV) over 24 h post-EVT. We used a logistic mixed-effects model to estimate the association [expressed as adjusted odds ratios (aOR)] between tertiles of BPV and outcomes of 90-day mortality, 90-day death or disability [modified Rankin Scale-score (mRS) > 2], 90-day functional impairment (⩾1-point increase across all mRS-scores), and symptomatic intracranial hemorrhage (sICH), adjusting for age, sex, stroke severity, co-morbidities, pretreatment with intravenous thrombolysis, successful recanalization, and mean SBP and diastolic-BP levels within the first 24 hours post EVT. Results: There were 2640 AIS-patients included in the analysis. The highest tertile of SBP-SD was associated with higher 90-day mortality (aOR:1.44;95% CI:1.08–1.92), 90-day death or disability (aOR:1.49;95% CI:1.18–1.89), and 90-day functional impairment (adjusted common OR:1.42;95% CI:1.18–1.72), but not with sICH (aOR:1.22;95% CI:0.76–1.98). Similarly, the highest tertile of SBP-CV was associated with higher 90-day mortality (aOR:1.33;95% CI:1.01–1.74), 90-day death or disability (aOR:1.50;95% CI:1.19–1.89), and 90-day functional impairment (adjusted common OR:1.38;95% CI:1.15–1.65), but not with sICH (aOR:1.33;95% CI:0.83–2.14). Conclusions: BPV after EVT appears to be associated with higher mortality and disability, independently of mean BP levels within the first 24 h post EVT. BPV in the first 24 h may be a novel target to improve outcomes after EVT for AIS.

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Section: Discussionmentioning

confidence: 99%

Association between blood pressure variability and outcomes after endovascular thrombectomy for acute ischemic stroke: An individual patient data meta-analysis

Palaiodimou,

Joundi,

Katsanos

et al. 2023

European Stroke Journal

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“…Additionally, spectral analysis for rapid BPV assessment shows promise in promptly identifying at-risk patients without requiring lengthy BP recordings [110]. After identifying patients at risk, imaging techniques, such as the assessment of the collateral status [111][112][113] and the degree of recanalisation post-endovascular treatment [114,115] or the evaluation of the dynamic brain autoregulation in real-time using near-infrared spectroscopy-derived tissue oxygenation [116] or transcranial doppler [117], could guide BP management within targeted and tighter ranges to prevent increased systolic BPV.…”

Section: Blood Pressure Variability Among Patients With Acute Ischaem...mentioning

confidence: 99%

Blood Pressure Variability in Acute Stroke: A Narrative Review

Zompola,

Palaiodimou,

Voumvourakis

et al. 2024

JCM

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The management of blood pressure variability (BPV) in acute stroke presents a complex challenge with profound implications for patient outcomes. This narrative review examines the role of BPV across various stages of acute stroke care, highlighting its impact on treatment strategies and prognostic considerations. In the prehospital setting, while guidelines lack specific recommendations for BP management, emerging evidence suggests a potential link between BPV and outcomes. Among ischaemic stroke patients who are ineligible for reperfusion therapies, BPV independently influences functional outcomes, emphasising the need for individualised approaches to BP control. During intravenous thrombolysis and endovascular therapy, the intricate interplay between BP levels, recanalisation status, and BPV is evident. Striking a balance between aggressive BP lowering and avoiding hypoperfusion-related complications is essential. Intracerebral haemorrhage management is further complicated by BPV, which emerges as a predictor of mortality and disability, necessitating nuanced BP management strategies. Finally, among patients with acute subarachnoid haemorrhage, increased BPV may be correlated with a rebleeding risk and worse outcomes, emphasizing the need for BPV monitoring in this population. Integration of BPV assessment into clinical practice and research protocols is crucial for refining treatment strategies that are tailored to individual patient needs. Future studies should explore novel interventions targeting BPV modulation to optimise stroke care outcomes.

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“…Although clinical studies have demonstrated the potential of portable MRI in complex clinical care settings ( Sheth et al, 2020 ), this device is not as sensitive to low-perfusion areas as professional perfusion imaging and is limited by a temporal window, preventing continuous tracking. The transcranial Doppler (TCD) technique allows for real-time evaluation of changes in cerebral hemodynamics and parenchymal structure through non-invasive measurement of CBF velocity ( Tao et al, 2021 ). However, the TCD method is effective in tracking perfusion of larger vessels and is less effective in detecting perfusion in small to medium-sized vessels and microvessels ( Gómez-Escalonilla et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Dynamic cerebral blood flow assessment based on electromagnetic coupling sensing and image feature analysis

Gong,

Zeng,

Jiang

et al. 2024

Front. Bioeng. Biotechnol.

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Dynamic assessment of cerebral blood flow (CBF) is crucial for guiding personalized management and treatment strategies, and improving the prognosis of stroke. However, a safe, reliable, and effective method for dynamic CBF evaluation is currently lacking in clinical practice. In this study, we developed a CBF monitoring system utilizing electromagnetic coupling sensing (ECS). This system detects variations in brain conductivity and dielectric constant by identifying the resonant frequency (RF) in an equivalent circuit containing both magnetic induction and electrical coupling. We evaluated the performance of the system using a self-made physical model of blood vessel pulsation to test pulsatile CBF. Additionally, we recruited 29 healthy volunteers to monitor cerebral oxygen (CO), cerebral blood flow velocity (CBFV) data and RF data before and after caffeine consumption. We analyzed RF and CBFV trends during immediate responses to abnormal intracranial blood supply, induced by changes in vascular stiffness, and compared them with CO data. Furthermore, we explored a method of dynamically assessing the overall level of CBF by leveraging image feature analysis. Experimental testing substantiates that this system provides a detection range and depth enhanced by three to four times compared to conventional electromagnetic detection techniques, thereby comprehensively covering the principal intracranial blood supply areas. And the system effectively captures CBF responses under different intravascular pressure stimulations. In healthy volunteers, as cerebral vascular stiffness increases and CO decreases due to caffeine intake, the RF pulsation amplitude diminishes progressively. Upon extraction and selection of image features, widely used machine learning algorithms exhibit commendable performance in classifying overall CBF levels. These results highlight that our proposed methodology, predicated on ECS and image feature analysis, enables the capture of immediate responses of abnormal intracranial blood supply triggered by alterations in vascular stiffness. Moreover, it provides an accurate diagnosis of the overall CBF level under varying physiological conditions.

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A Prospective Study to Investigate Controlling Blood Pressure Under Transcranial Doppler After Endovascular Treatment in Patients With Occlusion of Anterior Circulation

Cited by 7 publications

References 31 publications

Association between blood pressure variability and outcomes after endovascular thrombectomy for acute ischemic stroke: An individual patient data meta-analysis

Association between blood pressure variability and outcomes after endovascular thrombectomy for acute ischemic stroke: An individual patient data meta-analysis

Blood Pressure Variability in Acute Stroke: A Narrative Review

Dynamic cerebral blood flow assessment based on electromagnetic coupling sensing and image feature analysis

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