Blood pressure and collateral circulation in acute ischemic stroke

Alimu, Wufuer; Mijiti, Peierdun; Abudusalamu, Rena; Han, Dong; Jian, Chong-dong; Ma, Junwu; Xiao-ning, Zhao

doi:10.1007/s00059-018-4691-5

Cited by 19 publications

(21 citation statements)

References 20 publications

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“…However, the relationship between baseline BP and CC has been barely described. One study of AIS patients treated with intravenous thrombolytic therapy (with or without LVO) found that moderately elevated systolic BP was associated with good CC but with an inverse association of systolic BP and 3-month clinical outcome ( 8 ); another study found that lower systolic BP was associated with good CC but in patients with ICA occlusion during the first 3 days from stroke onset ( 9 ). In this regard, our study adds relevant information confirming that both systolic BP and mean BP at admission are inversely associated with the CS.…”

Section: Discussionmentioning

confidence: 99%

“…In some studies, a higher admission blood pressure (BP) ( 6 ) and BP drops during EVT ( 7 ) are associated with a poorer clinical outcome after EVT. However, there are scarce and contradictory data evaluating the effect of admission BP on CC in AIS ( 8 , 9 ). A better understanding of this relationship could lead to an optimisation of CC by a better management of pre-procedural and intra-procedural BP.…”

Section: Introductionmentioning

confidence: 99%

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Automated scoring of collaterals, blood pressure, and clinical outcome after endovascular treatment in patients with acute ischemic stroke and large-vessel occlusion

Guisado‐Alonso

Camps‐Renom²,

Delgado-Mederos³

et al. 2022

Front. Neurol.

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IntroductionWe aimed to determine whether the degree of collateral circulation is associated with blood pressure at admission in acute ischemic stroke patients treated with endovascular treatment and to determine its prognostic value.MethodsWe evaluated patients with anterior large vessel occlusion treated with endovascular treatment in a single-center prospective registry. We collected clinical and radiological data. Automated and validated software (Brainomix Ltd., Oxford, UK) was used to generate the collateral score (CS) from the baseline single-phase CT angiography: 0, filling of ≤10% of the occluded MCA territory; 1, 11–50%; 2, 51–90%; 3, >90%. When dichotomized, we considered that CS was good (CS = 2–3), or poor (CS = 0–1). We performed bivariate and multivariable ordinal logistic regression analysis to predict CS categories in our population. The secondary outcome was to determine the influence of automated CS on functional outcome at 3 months. We defined favorable functional outcomes as mRS 0–2 at 3 months.ResultsWe included 101 patients with a mean age of 72.1 ± 13.1 years and 57 (56.4%) of them were women. We classified patients into 4 groups according to the CS: 7 patients (6.9%) as CS = 0, 15 (14.9%) as CS = 1, 43 (42.6%) as CS = 2 and 36 (35.6%) as CS = 3. Admission systolic blood pressure [aOR per 10 mmHg increase 0.79 (95% CI 0.68–0.92)] and higher baseline NIHSS [aOR 0.90 (95% CI, 0.84–0.96)] were associated with a worse CS. The OR of improving 1 point on the 3-month mRS was 1.63 (95% CI, 1.10–2.44) favoring a better CS (p = 0.016).ConclusionIn acute ischemic stroke patients with anterior large vessel occlusion treated with endovascular treatment, admission systolic blood pressure was inversely associated with the automated scoring of CS on baseline CT angiography. Moreover, a good CS was associated with a favorable outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Automated scoring of collaterals, blood pressure, and clinical outcome after endovascular treatment in patients with acute ischemic stroke and large-vessel occlusion

Guisado‐Alonso

Camps‐Renom²,

Delgado-Mederos³

et al. 2022

Front. Neurol.

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“…Positron emission tomography and quantitative susceptibility mapping (QSM) studies have confirmed the existence of this compensatory process ( 49 - 52 ). In addition, the collateral circulation pathway in the brain gradually opens, providing an alternative vascular pathway for ischemic tissue ( 53 , 54 ). In stage II, the body’s reserve capacity is exhausted, and the ischemic tissue shows metabolic alterations and changes in pH.…”

Section: Discussionmentioning

confidence: 99%

Amide proton transfer-weighted magnetic resonance imaging for the diagnosis of symptomatic chronic intracranial artery stenosis: a feasibility study

Chen¹,

Dou²,

Mao³

et al. 2022

Quant Imaging Med Surg

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Background: Hemodynamic changes after intracranial artery stenosis (ICAS) or occlusion are important causes of metabolic alterations in tissue. This study aimed to explore the feasibility of using amide proton transfer-weighted (APTw) magnetic resonance imaging (MRI) to diagnose patients with symptomatic chronic ICAS based on pH variations caused by metabolite damage.Methods: Sixty-seven patients with clinically confirmed unilateral anterior circulation ICAS (≥70% arterial narrowing) and 20 healthy volunteers were recruited for the study. Each patient underwent an MRI examination including a T2 fluid-attenuated inversion recovery (T2-FLAIR) sequence, spin-echo echoplanar diffusion-weighted imaging (DWI), three-dimensional pseudo-continuous arterial spin labeling (pcASL), and an APTw sequence. Areas with abnormal perfusion and APTw effects were defined as perfusion/ pH matched areas; areas with abnormal perfusion but normal APTw effects were defined as perfusion/pH unmatched areas; the contralateral mirror areas were defined as the normal areas. Regions of interest (ROIs) were selected within these three areas, and the corresponding apparent diffusion coefficient (ADC), cerebral blood flow (CBF), and magnetization transfer ratio asymmetry (MTR asym ) were measured.Results: High intraclass correlation coefficient (ICC) values (0.78≤ ICCs ≤0.97; P<0.05) were observed between the two radiologists who independently performed the data analysis. Significant differences were found in CBF and MTR asym between the perfusion/pH matched, perfusion/pH unmatched, and normal areas [F (2,64) =288.5, 163.5; both P<0.05], but the ADC values were comparable between the three [F (2,64) =2.11; P>0.05]. Spearman correlation analysis revealed no significant correlation between changes in MTR asym and CBF (P>0.05). Finally, APTw showed a robust performance in diagnosing symptomatic chronic ICAS, with an area under the receiver operating characteristic curve (ROC) of 0.953 (sensitivity 97.01%; specificity 85.07%; cut-off value 1.005%). Conclusions:The present study has demonstrated that metabolic alterations are present in patients with symptomatic chronic ICAS. Our findings illustrate that APTw imaging could potentially serve as an effective method to provide a robust clinical diagnosis for patients with symptomatic chronic ICAS.

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“…Collateral circulation was scored as intermediate (ASITN grade: 2). 4 Through a tri-axial system, a reperfusion catheter (ACE 68, Penumbra, Alameda, CA) was brought in contact with the clot in 10 minutes. At the moment of the withdrawal of the thrombus-aspiration system, the clot was found neither in the aspiration pump nor in the reperfusion catheter.…”

Section: Acute Phase Managementmentioning

confidence: 99%

White thrombus as a possible feature of atypical stroke etiology: Coxiella burnetii as the primary cause of acute ischemic stroke

et al. 2021

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Acute ischemic stroke (AIS) is the most common neurologic complication of infective endocarditis. We describe a singular case report of a 62- year-old male with AIS related to the occlusion of the left middle cerebral artery. Thrombus-aspiration allowed retrieving a 6 millimeters white thrombus. The real-time polymerase chain reaction performed on the thrombus detected Coxiella Burnetii allowed the diagnosis of infective endocarditis (IE) and the identification of the specific pathogen. Coxiella Burnetii is an endemic, small, intracellular, gram-negative coccobacillus and it is a rare cause of IE. The management of AIS caused by IE remains controversial, although in the cases of major occlusion mechanical thrombectomy is associated with better clinical outcomes. IE patients could not present symptoms and signs related to the infection, therefore we underline the importance of the microbiological analysis of the retrieved thrombi especially when atypical etiology is suspected.

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Blood pressure and collateral circulation in acute ischemic stroke

Abstract: The development of collateral circulation in patients with acute ischemic stroke with ICA occlusion may be influenced by BP. A moderately decreased SBP is associated with good integrity of the collateral circulation in patients with acute ischemic stroke with occlusion of the ICA.

Cited by 19 publications

References 20 publications

Automated scoring of collaterals, blood pressure, and clinical outcome after endovascular treatment in patients with acute ischemic stroke and large-vessel occlusion

Automated scoring of collaterals, blood pressure, and clinical outcome after endovascular treatment in patients with acute ischemic stroke and large-vessel occlusion

Amide proton transfer-weighted magnetic resonance imaging for the diagnosis of symptomatic chronic intracranial artery stenosis: a feasibility study

White thrombus as a possible feature of atypical stroke etiology: Coxiella burnetii as the primary cause of acute ischemic stroke

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