Abstract TP34: Malignant CT Perfusion Profile is Associated With Increased Sensitivity to Blood Pressure Reductions During Endovascular Stroke Therapy
| Autor: | Anson Wang, Sreeja Kodali, Christoph Stretz, Andrew Silverman, Charles C. Matouk, Santiago Ortega Gutierrez, Gloria V Lopez Cardenas, Ryan Hebert, Kevin N. Sheth, Binbin Zheng-Lin, Lauren H Sansing, Tijil Agarwal, Joseph Schindler, Sumita Strander, Nils H Petersen |
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| Rok vydání: | 2019 |
| Předmět: |
Advanced and Specialized Nursing
medicine.medical_specialty business.industry Penumbra Perfusion scanning Blood flow medicine.disease Endovascular therapy Blood pressure Internal medicine Occlusion medicine Cardiology Neurology (clinical) Cardiology and Cardiovascular Medicine business Perfusion Stroke |
| Zdroj: | Stroke. 50 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/str.50.suppl_1.tp34 |
| Popis: | Background: After large-vessel occlusion (LVO), blood flow to the ischemic penumbra largely depends on collateral perfusion. Blood pressure (BP) reductions during endovascular therapy (EVT) have been associated with increased infarct size and unfavorable functional outcome. We hypothesized that patients with poor collateral circulation assessed using CT perfusion imaging are at increased risk for infarct progression associated with intraprocedural BP reductions. Methods: We prospectively enrolled 90 patients with LVO stroke who underwent perfusion imaging and EVT at two comprehensive stroke centers. Volumes of arterial tissue delay >10 seconds (ATD10) were estimated with RAPID software; a malignant profile was defined as ADT10 >100 ml. BP reduction was defined as the difference between baseline mean arterial pressure (MAP) at the start of EVT and the lowest MAP during the procedure. Sustained relative hypotension was calculated as the area between baseline MAP and continuous measurements of intraprocedural MAP. Results: Sixty-seven patients (mean age 67 ± 15, 38 F, mean NIHSS 16) who were successfully revascularized (TICI 2B/3) were included in analysis. Mean baseline MAP was 119 ± 23 mmHg and median BP reduction was 28 (IQR 20 - 53). These values did not differ significantly among those with malignant (n=19) and non-malignant (n=48) collateral profiles, yet average infarct volume on follow-up was significantly greater among patients with poor collaterals (65 mL vs 32 ml) after adjusting for age and admission NIHSS (p=0.029). A significant interaction was found between the malignant collateral profile and intraprocedural BP reduction (p=0.02, Figure 1A&B). Conclusions: Patients with malignant collateral profiles are more sensitive to BP reductions during EVT, leading them to develop significantly larger infarcts. These results emphasize the importance of intraprocedural blood pressure management for this at-risk group. |
| Databáze: | OpenAIRE |
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