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
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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