Abstract
AbstractBackgroundPersonalized blood pressure (BP) management for acute ischemic stroke patients after successful recanalization lacks evidence. Our study aimed to investigate whether the deviation of BP from cerebral autoregulation (CA) limits, either in duration or burden, is associated with worse outcomes.MethodsWe prospectively enrolled patients with acute large anterior circulation artery occlusive stroke who had achieved successful recanalization (mTICI 2b-3). CA was determined by measuring mean velocity index (Mx) using transcranial Doppler sonography (TCD). We calculated the percent time and the burden (defined as the time-BP area) with BP outside the CA limits of each subject within 48 hours after recanalization. The outcomes included unfavorable functional outcome (mRS scored 3-6) at 90 days, early neurological deterioration (END), infarct volume growth at 7 days, and symptomatic intracranial hemorrhage (sICH) within 48 hours.ResultsA total of 91 patients were enrolled. Entire failure of autoregulation was found in 31.9% (29 / 91) of patients. The burden with BP outside the CA limits was associated with poor functional outcome at 90 days (aORper 100 h·mmHg 1.29 [95% CI, 1.05 – 1.59]P=0.018). Both the percent time and the burden with BP out of the CA limits was correlated with END (aORper 10% time 1.38 [95% CI, 1.05 – 1.83]P=0.022, aORper 100h·mmHg 1.22 [95% CI, 1.01 – 1.48]P=0.039). The burden of BP that decreased below the CA lower limit was associated with infarct volume growth (adjustedβper 100 h·mmHg 5.47 [95% CI, 0.13 – 10.80]P=0.045). The percent time that BP exceeded the CA upper limit was associated with sICH (aORper 10% time 1.45 [95% CI, 1.01 – 2.07]P=0.043).ConclusionsBoth the percent time and burden of BP that deviates from the autoregulation-preserved range correlate with worse outcomes after successful recanalization. Further randomized control trials are warranted to examine the effectiveness of autoregulation-guided BP targets.
Publisher
Cold Spring Harbor Laboratory