Cerebral hemodynamics in stroke thrombolysis (CHiST) study

Abstract

Despite careful patient selection, successful recanalization in intravenous thrombolysis is only achieved in approximately 50% of cases. Understanding changes in cerebral autoregulation during and following successful recanalization in acute ischemic stroke patients who receive intravenous thrombolysis, may inform the management of common physiological perturbations, including blood pressure, in turn reducing the risk of reperfusion injury. Cerebral blood velocity (Transcranial Doppler), blood pressure (Finometer) and end-tidal carbon dioxide (capnography) were continuously recorded in 11 acute ischemic stroke patients who received intravenous thrombolysis (5 female, mean ± SD age 68±12 years) over 4-time points, during and at the following time intervals after intravenous thrombolysis: 23.9±2.6 hrs, 18.1±7.0 days and 89.6±4.2 days. Reductions in blood pressure (p = 0.04) were observed during intravenous thrombolysis. Reductions in heart rate (p<0.005) and critical closing pressure [Affected hemisphere (p = 0.02) and non-affected hemisphere (p<0.005)] were observed post intravenous thrombolysis. End-tidal CO 2 increased during the subacute and chronic stages (p = 0.028). Reduction in affected hemisphere phase at low frequency was observed during intravenous thrombolysis (p = 0.021) and at subsequent visits (p = 0.048). No changes were observed in cerebral blood velocity, coherence, gain and Autoregulation Index during the follow-up period. Intravenous thrombolysis in acute ischemic stroke patients induced changes in affected hemisphere phase and other key hemodynamic parameters, but not Autoregulation Index. Further investigation of cerebral autoregulation is warranted in a larger acute ischemic stroke cohort to inform its potential role in individualized management plans.

Effects of Continuous Infusion of Lidocaine under Ultrasound-Guided Cervical Sympathetic Ganglion Catheterization on Cerebral Hemodynamics and Thermal Imaging Characteristics of Head and Neck in Patients with Angioneurotic Headache

“…Lidocaine has been included in our country's Essential Drug List and can also be provided in primary hospitals. Therefore, in this study, the concentration of lidocaine continuously pumped by ultrasound-guided SG catheter was chosen to be 0.2% [ 22 ]. The results of this study showed that there was no statistical difference in the incidence of adverse events in patients with continuous pumping of lidocaine under ultrasound-guided SG catheterization compared with the incidence of adverse events in patients treated with conventional SGB.…”

Comparison of Efficacy and Safety of Recombinant Human Prourokinase and Alteplase in the Treatment of STEMI and Analysis of Influencing Factors of Efficacy

“…Since the anterior wall myocardial infarction is mostly the left main coronary artery, compared with the inferior wall myocardial infarction of the right coronary artery disease, its clinical symptoms are more serious, and the treatment time is faster, and the effect is better. Drug thrombolysis is generally effective within 2 hours, and it is not easy to cause complications, so timely thrombolysis is helpful to improve the recanalization rate of infarcted vessels [ 16 , 17 ].…”

Effect of drug interventions on cerebral hemodynamics in ischemic stroke patients

“…While the benefits of early intervention with r-tPA on arterial recanalization is wellestablished, the acute effects of thrombolysis on cerebral hemodynamics are less well-categorised. In a small cohort of 11 stroke patients, Lam et al 11 examined the effect of r-tPA infusion on dCA and found during treatment a reduced dCA (phase) within the affected hemisphere in some parameters, while cerebral blood flow velocity (CBFV) remained unchanged. Also noted was a drop in BP immediately before completion of r-tPA infusion, which could have been attributed to factors such as recovery from pain, but does mimic earlier findings in studies investigating streptokinase infusion in patients with myocardial infarction 12 and pulmonary embolism.…”