| Prognostic significance of blood pressure variability after thrombolysis in acute stroke. | |
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MedLine Citation:
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PMID: 18550860 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article Date: 2008-06-11 |
Journal Detail:
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Title: Neurology Volume: 71 ISSN: 1526-632X ISO Abbreviation: Neurology Publication Date: 2008 Aug |
Date Detail:
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Created Date: 2008-08-19 Completed Date: 2008-10-07 Revised Date: 2009-05-20 |
Medline Journal Info:
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Nlm Unique ID: 0401060 Medline TA: Neurology Country: United States |
Other Details:
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Languages: eng Pagination: 552-8 Citation Subset: AIM; IM |
Affiliation:
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Brain Hemodynamics Lab, Neurovascular Unit, Department of Neurology, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator |
| Comments/Corrections | |
Comment In:
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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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