Blood pressure variability and short-term outcomes after mechanical thrombectomy in patients with acute ischemic stroke

Zhou, Jiping; Samara, H; Ali, Ebrahim; Kinariwala, Jay; Mohamed, Wazim

doi:10.1016/j.jstrokecerebrovasdis.2023.107197

Cited by 2 publications

(1 citation statement)

References 31 publications

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“…Thus, the independent association of BPV with the clinical outcomes might be better explained by sustained hypoperfusion despite recanalisation [105,106], arguing against intensive BP reduction in this setting. In any case, given the strong association of BPV with short-term and long-term outcomes post-endovascular treatment [102,103,107], future research designs that incorporate BPV as a target within the BP management protocol are warranted. However, a key question arises: how can patients at risk of developing increased BPV be identified and effectively managed?…”

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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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

View full text Add to dashboard Cite

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Pretreatment Cranial Computed Tomography Perfusion Predicts Dynamic Cerebral Autoregulation Changes in Acute Hemispheric Stroke Patients Having Undergone Recanalizing Therapy: A Retrospective Study

Lakatos,

Bolognese,

Österreich

et al. 2024

Neurology International

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Objectives: Blood pressure (BP) management is challenging in patients with acute ischemic supratentorial stroke undergoing recanalization therapy due to the lack of established guidelines. Assessing dynamic cerebral autoregulation (dCA) may address this need, as it is a bedside technique that evaluates the transfer function phase in the very low-frequency (VLF) range (0.02–0.07 Hz) between BP and cerebral blood flow velocity (CBFV) in the middle cerebral artery. This phase is a prognostically relevant parameter, with lower values associated with poorer outcomes. This study aimed to evaluate whether early cranial computed tomography perfusion (CTP) can predict this parameter. Methods: In this retrospective study, 165 consecutive patients with hemispheric strokes who underwent recanalizing therapy were included (median age: 73 years; interquartile range (IQR) 60–80; women: 43 (26%)). The cohort comprised 91 patients treated with intravenous thrombolysis (IV-lysis) alone (median National Institute of Health Stroke Scale (NIHSS) score: 5; IQR 3–7) and 74 patients treated with mechanical thrombectomy (median NIHSS: 15; IQR 9–18). Regression analysis was performed to assess the relationship between pretreatment CTP-derived ischemic penumbra and core stroke volumes and the dCA VLF phase, as well as CBFV assessed within the first 72 h post-stroke event. Results: Pretreatment penumbra volume was a significant predictor of the VLF phase (adjusted r2 = 0.040; β = −0.001, 95% confidence interval (CI): −0.0018 to −0.0002, p = 0.02). Core infarct volume was a stronger predictor of CBFV (adjusted r2 = 0.082; β = 0.205, 95% CI: 0.0968–0.3198; p = 0.0003) compared to penumbra volume (p = 0.01). Additionally, in the low-frequency range (0.07–0.20 Hz), CBFV and BP were inversely related to the gain, an index of vascular tone. Conclusion: CTP metrics appear to correlate with the outcome-relevant VLF phase and reactive hyperemic CBFV, which interact with BP to influence vascular tone and gain. These aspects of dCA could potentially guide BP management in patients with acute stroke undergoing recanalization therapy. However, further validation is required.

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Blood pressure variability and short-term outcomes after mechanical thrombectomy in patients with acute ischemic stroke

Cited by 2 publications

References 31 publications

Blood Pressure Variability in Acute Stroke: A Narrative Review

Blood Pressure Variability in Acute Stroke: A Narrative Review

Pretreatment Cranial Computed Tomography Perfusion Predicts Dynamic Cerebral Autoregulation Changes in Acute Hemispheric Stroke Patients Having Undergone Recanalizing Therapy: A Retrospective Study

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