Detrimental effect of increased blood pressure variability on clinical outcome in acute ischemic stroke treated with reperfusion therapy: a case control study.

BACKGROUND: Blood pressure variability (BPV) is related to clinical outcome in acute ischemic stroke (AIS) treated with reperfusion therapy, but still is not included in clinical practice. This study aims to associate BPV during the first week of AIS with the outcome at three months. METHODS: We included 236 AIS patients treated with reperfusion therapy, and then divided them into good outcome and poor outcome groups. BPV measurements, including standard deviation, coefficient of variation, average real variability (ARV), and range, were recorded at stages of 2 h, 24 h, and 7 days after reperfusion therapy, respectively. These measurements were compared between the two groups. Then, ROC curve analysis examined the ability of BPV measurements in differentiating good and poor outcome groups; logistic regression analysis detected variables associated with clinical outcome in all subjects. RESULTS: The good outcome group exhibited significantly less BPV at all stages relative to the poor outcome group. The BPV measurements exhibited the potential to differentiate the two groups by the ROC curve analysis, especially for those at the 24-h stage. Higher ARV of diastolic BP and higher range of systolic BP at the 24-h stage, together with greater disease severity at baseline, were associated with poor clinical outcome. CONCLUSIONS: Greater BPV during the first week of AIS is associated with poor outcome for the patients treated with reperfusion therapy. The BPV measurements play an important role in modulating clinical outcome, and have the potential to be included in future AIS guidelines.

Prognostic significance of early systolic blood pressure variability after endovascular thrombectomy and intravenous thrombolysis in acute ischemic stroke: A systematic review and meta-analysis.

OBJECTIVES: Previous studies have shown inconsistent results regarding the effect of early systolic blood pressure variability (SBPV) after endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) on functional outcome in acute ischemic stroke (AIS). The systematic review and meta-analysis aimed to determine the effect of early SBPV after EVT and IVT on outcome in AIS. MATERIALS AND METHODS: We searched for articles published before February 2020 in the following databases: PubMed, Web of Science, EMBASE, Medline, and Google Scholar. The pooled multivariate odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs) were obtained using STATA 13.0 software. RESULTS: Increased early SBPV after EVT was significantly associated with worse functional outcome in AIS (OR = 1.42, 95% CI 1.02 to 1.99, I2  = 82.4%, p value of Q test < .001), whereas no significant associations were indicated between SBPV after IVT and functional outcome, symptomatic intracerebral hemorrhage (sICH) in AIS [functional outcome: RR = 1.08, 95% CI 0.96 to 1.22, I2  = 0.0%, p value of Q test = 0.793; sICH: RR = 2.40, 95% CI 0.71 to 8.03, I2  = 78.2%, p value of Q test = 0.01]. CONCLUSIONS: The present study provided evidence that increased early SBPV after EVT is related to worse longer-term functional outcome in AIS, but the association is not significant in AIS patients treated with IVT. Furthermore, individualized BP management strategies were essential for AIS patients after EVT or IVT.

Relationship between deep medullary veins in susceptibility-weighted imaging and ipsilateral cerebrovascular reactivity of middle cerebral artery in patients with ischemic stroke.

Deep cerebral veins have been recently associated with the severity of hemodynamic impairment in moyamoya disease. The aim of the current study was to determine the correlation of deep medullary veins (DMVs) in susceptibility-weighted imaging (SWI) with ipsilateral cerebrovascular reactivity (CVR) of and anterior cecebrocervical artery stenosis in patients with ischemic stroke. Patients with unilateral TIA or infarction who underwent 3.0 T magnetic resonance imaging SWI, digital subtraction angiography and transcranial Doppler with CO2 stimulation within the first 7 days of hospitalization were retrospectively selected. CVR and stenosis of anterior cerebrocervical arteries were compared between different DMVs stages in symptomatic hemispheres (SHs) and asymptomatic hemispheres (AHs). A total of 61 patients were subsequently included in the present study. A univariate analysis was conducted and results for age (PAHs=0.004, PSHs=0.006), hypertension (PAHs=0.008, PSHs=0.020), current smoking (PAHs=0.006, PSHs=0.021), CVR (PAHs=0.000, PSHs=0.000), and artery stenosis (PAHs=0.000, PSHs=0.000) were obtained. The results suggested statistically significant differences between DMVs grades in SHs and AHs. A subsequent multivariate analysis revealed that CVR (ORAHs=0.925, 95% CIAHs: 0.873-0.981; ORSHs=0.945, 95% CISHs: 0.896-0.996), and artery stenosis (ORAH=3.147, 95% CIAH: 1.010-9.806; ORSHs=2.882, 95% CISHs: 1.017-8.166) were independent risk factors of DMVs. In conclusion, 3.0 T SWI was useful in detecting the DMVs around the lateral ventricle in patients with atherosclerotic ischemic stroke. CVR and stenosis of anterior cerebrocervical arteries were independent risk factors for ipsilateral DMVs in SHs and AHs.