Document Detail


Prognostic significance of blood pressure variability after thrombolysis in acute stroke.
MedLine Citation:
PMID:  18550860     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the impact of early blood pressure (BP) changes on diffusion-weighted imaging (DWI) lesion evolution and clinical outcome in patients with stroke treated with IV tissue plasminogen activator (tPA). METHODS: We prospectively evaluated 80 patients with stroke with a documented middle cerebral artery occlusion treated with IV tPA. Multiple repeated systolic (SBP) and diastolic (DBP) BP measurements were obtained during 24 hours after admission. All patients underwent DWI, perfusion-weighted imaging, and magnetic resonance angiography before and 36-48 hours after thrombolysis. Recanalization was assessed on transcranial Doppler at 6 hours of stroke onset. NIH Stroke Scale scores were recorded at baseline and 24 hours. Modified Rankin Scale was used to assess 3-month outcome. RESULTS: Recanalization occurred in 44 (55%) patients. BP variability, estimated as the SD of the mean, was associated with DWI lesion growth (r = 0.46, p = 0.0003 for SBP and r = 0.26, p = 0.02 for DBP), early clinical course (p = 0.06 for SBP and p = 0.01 for DBP), and 3-month outcome (p = 0.002 for SBP and 0.07 for DBP). However, the prognostic significance of BP changes differed depending on the presence of recanalization. SBP variability emerged as an independent predictor of DWI lesion growth (beta: 6.9; 95% CI, 3.2 to 10.7, p = 0.003) and worse stroke outcome (OR: 11; 95% CI: 2.2 to 56.1; p = 0.004) in patients without recanalization, but not in recanalized patients. CONCLUSION: Blood pressure variability is associated with greater diffusion-weighted imaging lesion growth and worse clinical course in patients with stroke treated with IV tissue plasminogen activator. However, its impact varies depending on the occurrence of early recanalization after thrombolysis.
Authors:
R Delgado-Mederos; M Ribo; A Rovira; M Rubiera; J Munuera; E Santamarina; P Delgado; O Maisterra; J Alvarez-Sabin; C A Molina
Publication Detail:
Type:  Journal Article     Date:  2008-06-11
Journal Detail:
Title:  Neurology     Volume:  71     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-19     Completed Date:  2008-10-07     Revised Date:  2009-05-20    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  552-8     Citation Subset:  AIM; IM    
Affiliation:
Brain Hemodynamics Lab, Neurovascular Unit, Department of Neurology, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Blood Pressure / drug effects*
Diastole
Diffusion Magnetic Resonance Imaging
Disease Progression
Female
Fibrinolytic Agents / administration & dosage
Humans
Infarction, Middle Cerebral Artery / diagnosis,  drug therapy*
Magnetic Resonance Angiography
Male
Predictive Value of Tests
Prognosis
Prospective Studies
Regression Analysis
Risk Factors
Stroke / diagnosis,  drug therapy*
Systole
Thrombolytic Therapy / methods*
Tissue Plasminogen Activator / administration & dosage
Treatment Outcome
Ultrasonography, Doppler, Transcranial
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections
Comment In:
Neurology. 2009 May 19;72(20):1793   [PMID:  19451540 ]
Neurology. 2009 May 19;72(20):1792-3; author reply 1792-3   [PMID:  19451539 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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