Ana Inês Martins1, João Sargento-Freitas1, Fernando Silva1, Joana Jesus-Ribeiro1, Inês Correia1, João Pedro Gomes2, Mariana Aguiar-Gonçalves1, Leila Cardoso1, Cristina Machado1, Bruno Rodrigues1, Gustavo C Santo1, Luís Cunha1. 1. From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.). 2. From the Departments of Neurology (A.I.M., J.S.-F., F.S., J.J.-R., I.C., C.M., B.R., G.C.S., L.C.) and Internal Medicine (J.P.G., M.A.-G., L.C.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; and Neurology Department, Faculdade de Medicina da Universidade de Coimbra, Coimbra University, Coimbra, Portugal (J.S.-F., L.C.). jsargentof@hotmail.com.
Abstract
BACKGROUND AND PURPOSE: Historical stroke cohorts reported a U- or J-shaped relationship between blood pressure (BP) and clinical outcome. However, these studies predated current revascularization strategies, disregarding the recanalization state of the affected arterial territory. We aimed to investigate the relationship between BP in the first 24 hours after ischemic stroke and clinical outcome in patients submitted to intravenous or intra-arterial recanalization treatments. METHODS: Consecutive patients with acute stroke treated with intravenous thrombolysis or intra-arterial therapies were enrolled in a retrospective cohort study. BP was measured on regular intervals throughout day and night during the first 24 hours after stroke onset. The mean systolic BP and diastolic BP during the first 24 hours post stroke were calculated. Recanalization was assessed at 6 hours by transcranial color-coded Doppler, angiography, or angio-computed tomography. Functional outcome was assessed at 3 months by modified Rankin Scale. Linear and quadratic multivariate regression models were performed to determine associations between BP and functional outcome for the whole population and recanalyzed and nonrecanalyzed patients. RESULTS: We included 674 patients; mean age was 73.28 (SD, 11.50) years. Arterial recanalization was documented in 355 (52.70%) patients. In multivariate analyses, systolic BP and diastolic BP in the first 24 hours post stroke show a J-shaped relationship with functional outcome in the total population and in the nonrecanalyzed patients. Recanalyzed patients show a linear association with functional outcome (systolic BP: odds ratio, 1.015; 95% confidence interval, 1.007-1.024; P=0.001; R(2) change=0.001; P=0.412 and diastolic BP: odds ratio, 1.019; 95% confidence interval, 1.004-1.033; P=0.012; R(2) change<0.001; P=0.635). CONCLUSIONS: Systemic BP in the first 24 hours after ischemic stroke influences 3-month clinical outcome. This association is dependent on the revascularization status.
BACKGROUND AND PURPOSE: Historical stroke cohorts reported a U- or J-shaped relationship between blood pressure (BP) and clinical outcome. However, these studies predated current revascularization strategies, disregarding the recanalization state of the affected arterial territory. We aimed to investigate the relationship between BP in the first 24 hours after ischemic stroke and clinical outcome in patients submitted to intravenous or intra-arterial recanalization treatments. METHODS: Consecutive patients with acute stroke treated with intravenous thrombolysis or intra-arterial therapies were enrolled in a retrospective cohort study. BP was measured on regular intervals throughout day and night during the first 24 hours after stroke onset. The mean systolic BP and diastolic BP during the first 24 hours post stroke were calculated. Recanalization was assessed at 6 hours by transcranial color-coded Doppler, angiography, or angio-computed tomography. Functional outcome was assessed at 3 months by modified Rankin Scale. Linear and quadratic multivariate regression models were performed to determine associations between BP and functional outcome for the whole population and recanalyzed and nonrecanalyzed patients. RESULTS: We included 674 patients; mean age was 73.28 (SD, 11.50) years. Arterial recanalization was documented in 355 (52.70%) patients. In multivariate analyses, systolic BP and diastolic BP in the first 24 hours post stroke show a J-shaped relationship with functional outcome in the total population and in the nonrecanalyzed patients. Recanalyzed patients show a linear association with functional outcome (systolic BP: odds ratio, 1.015; 95% confidence interval, 1.007-1.024; P=0.001; R(2) change=0.001; P=0.412 and diastolic BP: odds ratio, 1.019; 95% confidence interval, 1.004-1.033; P=0.012; R(2) change<0.001; P=0.635). CONCLUSIONS: Systemic BP in the first 24 hours after ischemic stroke influences 3-month clinical outcome. This association is dependent on the revascularization status.
Authors: Wesley B Baker; Ramani Balu; Lian He; Venkaiah C Kavuri; David R Busch; Olivia Amendolia; Francis Quattrone; Suzanne Frangos; Eileen Maloney-Wilensky; Kenneth Abramson; Elizabeth Mahanna Gabrielli; Arjun G Yodh; W Andrew Kofke Journal: J Cereb Blood Flow Metab Date: 2019-05-14 Impact factor: 6.200
Authors: Mariana Carvalho Dias; Denis Gabriel; Marlene Saraiva; Daniel Campos; Manuel Requena; Álvaro García-Tornel; Marian Muchada; Sandra Boned; David Rodriguez-Luna; Noelia Rodriguez-Villatoro; Jorge Pagola; Jesus Juega; Matías Deck; Marc Ribo; Alejandro Tomasello; Carlos A Molina; Marta Rubiera Journal: Eur Stroke J Date: 2020-06-11
Authors: Eva A Mistry; Akshitkumar M Mistry; Mohammad Obadah Nakawah; Nicolas K Khattar; Enzo M Fortuny; Aurora S Cruz; Michael T Froehler; Rohan V Chitale; Robert F James; Matthew R Fusco; John J Volpi Journal: J Am Heart Assoc Date: 2017-05-18 Impact factor: 5.501
Authors: Robert W Regenhardt; Alvin S Das; Christopher J Stapleton; Ronil V Chandra; James D Rabinov; Aman B Patel; Joshua A Hirsch; Thabele M Leslie-Mazwi Journal: Front Neurol Date: 2017-07-03 Impact factor: 4.003
Authors: Adam de Havenon; Nils Petersen; Ali Sultan-Qurraie; Matthew Alexander; Shadi Yaghi; Min Park; Ramesh Grandhi; Eva Mistry Journal: Semin Neurol Date: 2021-01-20 Impact factor: 3.420
Authors: Benjamin Maïer; Benjamin Gory; Guillaume Taylor; Julien Labreuche; Raphaël Blanc; Michael Obadia; Marie Abrivard; Stanislas Smajda; Jean-Philippe Desilles; Hocine Redjem; Gabriele Ciccio; Anne Claire Lukaszewicz; Francis Turjman; Roberto Riva; Paul Emile Labeyrie; Alain Duhamel; Jacques Blacher; Michel Piotin; Bertrand Lapergue; Mikael Mazighi Journal: J Am Heart Assoc Date: 2017-10-10 Impact factor: 5.501