Marco Meyer1, Martin Juenemann2, Tobias Braun2, Ingo Schirotzek2, Christian Tanislav3, Kristin Engelhard4, Patrick Schramm4. 1. Department of Geriatrics, Jung-Stilling Hospital Siegen, Siegen, Germany. Electronic address: marco.meyer@diakonie-sw.de. 2. Department of Neurology, University hospital Giessen and Marburg location Giessen, Giessen, Germany. 3. Department of Geriatrics, Jung-Stilling Hospital Siegen, Siegen, Germany. 4. Department of Anesthesiology, Johannes Gutenberg-University, University medical hospital Mainz, Mainz, Germany.
Abstract
INTRODUCTION: Successful thrombectomy improves morbidity and mortality after stroke. The present prospective, observational cohort study investigated a potential correlation between the successful restoration of tissue perfusion by mechanical thrombectomy and intact cerebrovascular autoregulation (CA). OBJECTIVE: Status of CA in patients with large vessel occlusive stroke after thrombectomy. METHODS: After thrombectomy CA was measured using transcranial Doppler ultrasound. For this purpose a moving correlation index (Mxa) based on spontaneous arterial blood pressure fluctuations and corresponding cerebral blood flow velocity changes was calculated. CA impairment was defined by Mxa values more than .3. RESULTS: Twenty patients with an acute occlusion of the middle cerebral artery or distal internal carotid artery were included. A successful recanalization of the occluded vessel via interventional thrombectomy was achieved in 10 of these patients (successful recanalization group), while in 10 patients mechanical recanalization failed or could not be applied (no recanalization group). Mean Mxa at stroke side was .58 ± .21 Table 2a in patients with successful intervention. At the unaffected hemisphere Mxa was .50 ± .20 Table 2a in successful recanalization group and .45 ± .24 Table 2b in no recanalization group without statistically significant differences. Based on the previously defined Mxa cut off more than .3, CA impairment was observable in all successful recanalized patients and in 8 of 10 patients with unsuccessful interventional treatment. CONCLUSIONS: These results suggest that brain perfusion may be affected due to impaired CA even after successful mechanical thrombectomy. Therefore, a tight blood pressure management is of great importance in post-thrombectomy stroke treatment to avoid cerebral hypo- and hyperperfusion.
INTRODUCTION: Successful thrombectomy improves morbidity and mortality after stroke. The present prospective, observational cohort study investigated a potential correlation between the successful restoration of tissue perfusion by mechanical thrombectomy and intact cerebrovascular autoregulation (CA). OBJECTIVE: Status of CA in patients with large vessel occlusive stroke after thrombectomy. METHODS: After thrombectomy CA was measured using transcranial Doppler ultrasound. For this purpose a moving correlation index (Mxa) based on spontaneous arterial blood pressure fluctuations and corresponding cerebral blood flow velocity changes was calculated. CA impairment was defined by Mxa values more than .3. RESULTS: Twenty patients with an acute occlusion of the middle cerebral artery or distal internal carotid artery were included. A successful recanalization of the occluded vessel via interventional thrombectomy was achieved in 10 of these patients (successful recanalization group), while in 10 patients mechanical recanalization failed or could not be applied (no recanalization group). Mean Mxa at stroke side was .58 ± .21 Table 2a in patients with successful intervention. At the unaffected hemisphere Mxa was .50 ± .20 Table 2a in successful recanalization group and .45 ± .24 Table 2b in no recanalization group without statistically significant differences. Based on the previously defined Mxa cut off more than .3, CA impairment was observable in all successful recanalized patients and in 8 of 10 patients with unsuccessful interventional treatment. CONCLUSIONS: These results suggest that brain perfusion may be affected due to impaired CA even after successful mechanical thrombectomy. Therefore, a tight blood pressure management is of great importance in post-thrombectomy stroke treatment to avoid cerebral hypo- and hyperperfusion.
Authors: Mais Al-Kawaz; Sung-Min Cho; Rebecca F Gottesman; Jose I Suarez; Lucia Rivera-Lara Journal: Neurocrit Care Date: 2022-04-05 Impact factor: 3.210
Authors: Ricardo C Nogueira; Marcel Aries; Jatinder S Minhas; Nils H Petersen; Li Xiong; Jana M Kainerstorfer; Pedro Castro Journal: J Cereb Blood Flow Metab Date: 2021-09-13 Impact factor: 6.960