Determinants of the impact of blood pressure variability on neurological outcome after acute ischaemic stroke
Autor: | Gordon Smith, Steve O’Donnell, Lee S Chung, Adam de Havenon, J. Scott McNally, Gregory J. Stoddard, Jennifer J. Majersik, David L. Tirschwell, Alicia Bennett |
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Rok vydání: | 2017 |
Předmět: |
Male
Time Factors Computed Tomography Angiography viruses Blood Pressure Perfusion scanning 030204 cardiovascular system & hematology Disability Evaluation Patient Admission 0302 clinical medicine Risk Factors Modified Rankin Scale 10. No inequality Stroke medicine.diagnostic_test Penumbra Middle Aged Prognosis 3. Good health Cerebrovascular Circulation Cardiology Female Original Article medicine.symptom Cardiology and Cardiovascular Medicine Adult medicine.medical_specialty Perfusion Imaging Collateral Circulation Neuroimaging Lesion 03 medical and health sciences Predictive Value of Tests Internal medicine medicine Humans Aged Ischemic Stroke Retrospective Studies business.industry Blood Pressure Determination Recovery of Function medicine.disease Cerebral Angiography Surgery Blood pressure Angiography CT perfusion Neurology (clinical) business 030217 neurology & neurosurgery |
Zdroj: | Stroke and Vascular Neurology |
ISSN: | 2059-8696 2059-8688 |
Popis: | Introduction Increased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explored. Methods We retrospectively reviewed inpatients from 2007 to 2014 with acute anterior circulation ischaemic stroke, CT perfusion and angiography at hospital admission, and a modified Rankin Scale (mRS) 30–365 days after stroke onset. BPV indices included SD, coefficient of variation and successive variation of the systolic blood pressure between 0 and 120 hours after admission. Ordinal logistic regression models were fitted to mRS with predictor variables of BPV indices. Models were further stratified by CT perfusion volumetric measurements, proximal vessel occlusion and collateral score. Results 110 patients met the inclusion criteria. The likelihood of a 1-point rise in the mRS increased with every 10 mm Hg increase in BPV (OR for the 3 BPV indices ranged from 2.27 to 5.54), which was more pronounced in patients with larger ischaemic core volumes (OR 8.37 to 18.0) and larger hypoperfused volumes (OR 6.02 to 15.4). This association also held true for patients with larger mismatch volume, proximal vessel occlusion and good collateral vessels. Conclusions These results indicate that increased BPV is associated with worse neurological outcome after stroke, particularly in patients with a large lesion core volume, concurrent viable ischaemic penumbra, proximal vessel occlusion and good collaterals. This subset of patients, who are often not candidates for or fail acute stroke therapies such as intravenous tissue plasminogen activator or endovascular thrombectomy, may benefit from interventions aimed at reducing BPV. |
Databáze: | OpenAIRE |
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