Early blood pressure changes during systemic thrombolysis and its association with unexplained early neurological deterioration in small subcortical infarct

Abstract

Early neurological deterioration (END), observed in the acute phase of small subcortical infarct treated with intravenous thrombolysis (IVT), is not uncommon in these patients. However, in over half of the END cases, the exact cause is yet incompletely understood, which is so‐called unexplained END (unEND). Our aim was to investigate the association of early blood pressure (BP) changes with unEND in patients with small subcortical infarct in the perforator territory of middle cerebral artery treated with IVT. Consecutive patients with acute small subcortical infarct treated with IVT were enrolled in this study. unEND was defined as≧2‐point increase of NIHSS from baseline to 24 hours, without straightforward causes. BP excursions and BP variability were calculated and compared between patients with unNED and those without. A total of 168 patients with acute small subcortical infarct were included. Of them, there were 29 patients with unEND and 139 without END. During the first 24 hours following IVT, 66 (39.29%) patients had at least one BP excursion. Logistic regression analyses indicated that BP excursion presence (OR = 3.185, 95% CI: 1.238‐8.198), SBP excursion presence (OR = 3.535, 95% CI: 1.366‐9.143), and number of SBP excursion (OR = 1.466, 95% CI: 1.090‐1.973) were independently associated with unEND. Although SBPSD (P < .001) and SBPCV (P < .001) were higher in patients with unEND than those without END, none of the parameters of BP variability predicted unEND in multivariate analyses. BP excursions above guideline thresholds during the first 24 hours following IVT for small subcortical infarct are common and are independently associated with unEND.

Effects of glycemic indicators on early neurological outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis

“…Based on the results of the present study, the clinical symptoms were improved in 156 patients (19.0%), unchanged in 455 patients (55.6%)and deteriorated in 208 patients (25.4%) during the rst 24 h after IVT. Our results were consistent with previous studies showing signi cant individual differences in the effects of IVT therapy [9,29,30].…”

Blood Pressure Variability in Acute Stroke: A Narrative Review

“…On the other hand, BPV did not appear to be associated with early neurological deterioration specifically among patients with small subcortical infarcts treated with intravenous thrombolysis [67]. Similarly, in another more fragile patient subgroup, those with symptomatic intracranial artery stenosis or occlusion, BPV, as expressed by standard deviation, was again not associated with early neurological deterioration, although there was a clear negative association with 3-month functional outcomes [68].…”

Blood pressure excursion on admission and intravenous thrombolysis in ischemic stroke

“…Second, an inverse relationship of high BP levels and the likelihood of alteplase-induced recanalization was observed previously [6,17], and patients with BP excursion might had inferior recanalization rate. Additional speculation was that the excursion and quick decline might lead to high BP fluctuation, which was related to impaired cerebral autoregulation and reperfusion [16,18,19].…”