Effect of drug interventions on cerebral haemodynamics in ischaemic stroke patients

Abstract

The ischaemic penumbra is sensitive to alterations in cerebral perfusion. A myriad of drugs are used in acute ischaemic stroke (AIS) management, yet their impact on cerebral haemodynamics is poorly understood. As part of the Cerebral Autoregulation Network led INFOMATAS project ( Identifying New Targets for Management and Therapy in Acute Stroke), this paper reviews some of the most common drugs a patient with AIS will come across and their potential influence on cerebral haemodynamics with a particular focus being on cerebral autoregulation (CA). We first discuss how compounds that promote clot lysis and prevent clot formation could potentially impact cerebral haemodynamics, before focusing on how the different classes of antihypertensive drugs can influence cerebral haemodynamics. We discuss the different properties of each drug and their potential impact on cerebral perfusion and CA. With emerging interest in CA status of AIS patients, either during or soon after treatment when timely reperfusion and salvageable tissue is at its most critical, the properties of these pharmacological agents may be relevant for modelling cerebral perfusion accuracy and for setting individualised treatment strategies.