Prognostic significance of blood pressure variability after thrombolysis in acute stroke

Delgado‐Mederos, Raquel; Ribó, Marc; Rovira, Àlex; Rubiera, Marta; Munuera, Josep; Santamarina, Esteban; Delgado, Pilar; Maisterra, Olga; Alvarez-Sabin, José; Molina, Carlos A.

doi:10.1212/01.wnl.0000318294.36223.69

Cited by 130 publications

(114 citation statements)

References 20 publications

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“…In the setting of LVO patients treated with intravenous thrombolysis, BP variability was shown to be associated with Diffusion Weighted Imaging lesion growth and 90‐day outcome, especially in non‐recanalizers 15. By contrast, we did not find an interaction with recanalization status, which might partly be explained by the modest number of BP collected after recanalization.…”

Section: Discussioncontrasting

confidence: 76%

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Maïer

Turc

Taylor

et al. 2018

JAHA

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BackgroundStudies on the role of blood pressure (BP) variability specifically during mechanical thrombectomy (MT) are sparse and limited. Moreover, pulse pressure (PP) has not been considered as a potent hemodynamic parameter to describe BP variability during MT. We assessed the impact of PP variability on functional outcome in acute ischemic stroke patients with large vessel occlusion during MT.Methods and ResultsAcute ischemic stroke patients presenting with large vessel occlusion from January 2012 to June 2016 were included. BP data during MT were prospectively collected in the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Logistic regression models were used to assess the association between PP coefficients of variation and functional outcome at 3 months (modified Rankin Scale). Among the 343 included patients, PP variability was significantly associated with worse 3‐month modified Rankin Scale in univariable (odds ratio [OR]=1.56, 95% confidence interval [CI]: 1.24–1.96 per 1‐unit increase, P=0.0002) and multivariable ordinal logistic regression (adjusted OR=1.40, 95% CI: 1.09–1.79, P=0.008). PP variability was also associated with unfavorable outcome (modified Rankin Scale 3–6) in univariable (OR=1.53, 95% CI: 1.17–2.01, P=0.002) and multivariable analysis (adjusted OR=1.42, 95% CI: 1.02–1.98, P=0.04). There was an association between PP variability and 3‐month all‐cause mortality in univariable analysis (OR= 1.37, 95% CI: 1.01–1.85 per 1‐unit increase of the coefficient of variation of the PP, P=0.04), which did not remain significant after adjustment for potential confounders.Conclusions PP variability during MT is an independent predictor of worse clinical outcome in acute ischemic stroke patients. These findings support the need for a close monitoring of BP variability during MT. Whether pharmacological interventions aiming at reducing BP variability during MT could impact functional outcome needs to be determined.

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Section: Discussioncontrasting

confidence: 76%

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Maïer

Turc

Taylor

et al. 2018

JAHA

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“…As mentioned earlier, the second ECASS study cohort has reported that higher the systolic pressure before and after t-PA injection, higher the risk of PH 7 . There have also been studies suggesting that risk factor of PH is not systolic pressure before t-PA injection, but systolic pressure 24 hours post-injection 13,14 .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, ischemic penumbra indicates a state hypoperfusion when the blood pressure of the body is reduced or hyperfusion when the blood pressure of the body is increased. The reason behind larger BP variability negatively affecting the patient's prognosis is the changes in blood flow of the ischemic penumbra around the ischemic stroke lesion 13,15 .…”

Section: Discussionmentioning

confidence: 99%

Blood pressure variability and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke

Lee¹

2016

J Neurol Neuromedicine

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The effectiveness of intravenous tissue plasminogen activator (t-PA) is well established in hyperacute ischemic stroke. Despite its efficacy, spontaneous intracranial hemorrhage after t-PA is a severe complication associated with poor prognosis. We evaluated the role of blood pressure (BP) and BP variability, measured before and after injection of t-PA within 24 hours. Herein, 116 patients were enrolled in this study. BP (systolic blood pressure, diastolic blood pressure, and pulse pressure) were recorded before t-PA and every hour after t-PA for 24 hours. The BP profiles were characterized by initial, mean, maximum (max), minimum (min), max-min, and standard deviation (sd). The intracranial hemorrhage was assessed via computed tomography, 24-36 hours after injection of t-PA. The hemorrhagic transformation was classified using clinical and radiological criteria as follows: hemorrhagic transformation (HT), parenchymal hemorrhage (PH), and symptomatic hemorrhage (SH). The intracranial hemorrhage occurred as follows: HT 25.52% (n=25), PH 10.81% (n=12), SH 3.60% (n=4). The PPsd during the 24-hour period post-injection (24h PPsd) was significantly higher in patients with HT (14.57±0.76 vs. 11.84±0.39, 95% confidence interval [CI] 1.07-4.40, p<0.001) and PH (16.74±4.17 vs. 11.93±3.48, p<0.001). The odds ratio per 5 mmHg of 24h-PPsd was 2.41 (95% CI 1.23-4.72) in HT and 4.76 (95% CI 1.60-12.17) in PH. The variability in pulse pressure during the first 24 hours may be associated with hemorrhagic transformation after thrombolytic therapy with t-PA in hyperacute infarction.

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“…This evidence is supported by spontaneous reductions in BP after recanalization 34 and increases in infarct volume in the setting of large BP fluctuations without recanalization. 35 Furthermore, hemorrhagic transformation after thrombolytic therapy, consistent with recanalization and the potential for increased brain edema, was associated with a trend toward lower SBP. 36 Conversely, in the setting of thrombolytic therapy, there is significant evidence supporting an association with elevated BP and intracerebral hemorrhage.…”

Section: Blood Pressure Management In the Setting Of Thrombolytic Andmentioning

confidence: 93%

Neurocritical care and periprocedural blood pressure management in acute stroke

Sheth

Sims²

2012

Neurology

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The purpose of this article is to review the literature on periprocedural blood pressure (BP) management in acute ischemic stroke and to establish guidelines regarding management of BP. These guidelines are drawn from available evidence and expert opinion. This article reviews the pathophysiologic considerations of BP in ischemic stroke. It also examines the natural history of BP changes during stroke, as well as data on induced BP reduction and hypertension, particularly in light of reperfusion therapy. Finally, the article reviews major ongoing clinical trials for BP management in this setting. Recommendations made in this article may serve as a benchmark for future research in BP management in this patient population. Neurology ® 2012;79 (Suppl 1):S199-S204

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Prognostic significance of blood pressure variability after thrombolysis in acute stroke

Abstract: Blood pressure variability is associated with greater diffusion-weighted imaging lesion growth and worse clinical course in patients with stroke treated with IV tissue plasminogen activator. However, its impact varies depending on the occurrence of early recanalization after thrombolysis.

Cited by 130 publications

References 20 publications

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Blood pressure variability and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke

Neurocritical care and periprocedural blood pressure management in acute stroke

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