Abstract WP83: The Relationship Between Decline in Blood Pressure and Recanalization in Acute Ischemic Stroke
Objectives: We aimed to validate the hypothesis that decline in blood pressure (BP) predicts recanalization after intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with central occlusions of anterior circulation.
Methods: AIS patients treated with IVT were retrospectively collected at local hospital from April 2011 to December 2014. Blood pressure and clinical symptoms [measured as National Institute of Health Stroke Scale, (NIHSS)] were recorded within 24 hours after IVT. The cutoff points of the decline in systolic and diastolic BP were defined as ≥20 and ≥10 mm Hg, respectively. Neurological improvement (NI) was defined as ≥ 4 points improvement on NIHSS or an NIHSS score of 0 at 24h after IVT. Recanalization of the responsible cerebral vessel was detected by transcranial doppler (TCD) within 24 hours and confirmed by CT angiography (CTA) within 36h after admission. The pulsatility index (PI) measured by TCD were used to reflect vascular resistance, with 0.83 as the cutoff value of high- resistance in the middle cerebral artery (MCA). A logistic regression model was conducted to determine the predictors of recanalization.
Results: A total of 72 central occlusive AIS cases were enrolled after exclusion of 130 other IVT patients. The median age was 64 (IQR 56-71) years and 27.8% were female. The rates of NI and high- resistance of the affected MCA were more frequent in the subgroup with recanalization. The PI was much lower (0.87 vs. 0.97; P=0.005) in the affected side of MCA than the contralateral side. In the multivariate logistic regression models, NI [odds ratio (OR), 16.16; 95% confidence interval (CI), 2.40-108.83; P=0.004], hyperdense sign of MCA (OR, 7.17; 95%CI, 1.05-48.92; P=0.044), and low-resistance (PI<0.83) in the responsible MCA (OR, 30.18; 95%CI, 3.61-252.49; P=0.002) were significantly associated with recanalization. Decline either in SBP or DBP was not a predictor.
Conclusion: Our study fail to validate the hypothesis that decline in BP predicts recanalization after IVT in AIS patients with anterior circulation occlusion. Decline in BP could be a subresult of the recanalization, which could have been attributed to the release of resistance in the small vessels around the infarct lesions.
Author Disclosures: Q. Ma: None. Q. Huang: None. W. Feng: None. B. Ovbiagele: None. X. Ji: None. J. Jia: None. Y. Wang: None. M. Wang: None. J. Ding: None. Y. Hua: None. H. Song: None.
- © 2016 by American Heart Association, Inc.