June 22, 2021Open Access

Effects Of Early-Stage Blood Pressure Variability On The Functional Outcome In Acute Ischemic Stroke Patients With Symptomatic Intracranial Arterial Stenosis Or Occlusion Receiving Intravenous Thrombolysis

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke with symptomatic intracranial arterial stenosis or occlusion (n=110). Intervention: High systolic blood pressure successive variation (SV > 75%) vs. Lowest quartile of successive variation (SV < 25%). Primary outcome: Poor functional outcome at 3 months (mRS ≥ 2) (OR 8.676, 95% CI 1.892-39.775, p=0.005).

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Key result

High systolic blood pressure successive variation within 24 hours of thrombolysis significantly increased the risk of poor 3-month outcome (OR 8.676) in acute ischemic stroke patients with SIASO.

Why the study?

Studies exploring the relationship between blood pressure fluctuations and outcome in AIS patients treated with IVT are limited.

Does high blood pressure variability during the first 24 hours after intravenous thrombolysis worsen 3-month functional outcome in acute ischemic stroke patients with symptomatic intracranial arterial stenosis or occlusion?

Population

110 consecutive AIS patients with SIASO who received IVT

Comparison

Different levels or quartiles of blood pressure variability parameters during the first 24 hours after IVT

Design

Retrospective cohort study

Follow-up

90 days after onset

Authors

MYMian-Xuan YaoDongguan People’s Hospital DQDong‐Hai QiuDongguan People’s Hospital JZJianghao ZhaoHarbin Institute of Technology

Discussion

Member takes

Implication

BPV after IVT may associate with END and poorer outcome in SIASO; hypothesis-generating and requires prospective confirmation.

Study Design

Type

Cohort (n=110)

Multicenter

Structured PICO

Population

110 adult patients with acute ischemic stroke and symptomatic intracranial arterial stenosis or occlusion treated with intravenous thrombolysis, followed for 3 months.

Exposure

High systolic blood pressure variability (successive variation [SV] > 50th percentile) during the first 24 hours after intravenous thrombolysis

Comparator

Low systolic blood pressure variability (SV < 25th percentile)

Outcome

Early neurological deterioration (NIHSS increase ≥4 points within 72 hours) and 3-month functional outcome (modified Rankin Scale score, favorable ≤1 vs poor ≥2)hard clinical

Main Result

Odds Ratio: 8.676 (95% CI 1.892–39.775)

p-value: p=0.005

Higher systolic blood pressure variability in the first 24 hours after intravenous thrombolysis is associated with a significantly increased risk of poor 3-month functional outcome in acute ischemic stroke patients with symptomatic intracranial arterial stenosis or occlusion.

Limitations

Relatively small sample size
Retrospective study design
Magnetic resonance angiography might overestimate symptomatic intracranial arterial stenosis or occlusion compared to digital subtraction angiography
Intermittent cuff measurement was used to monitor blood pressure instead of continuous or invasive monitoring
Small sample size
Retrospective design
Use of magnetic resonance angiography instead of digital subtraction angiography might overestimate SIASO
Intermittent cuff measurement used to monitor BP instead of continuous or invasive monitoring

Cite This Study

Yao et al. (2021) conducted a cohort in Acute ischemic stroke with symptomatic intracranial arterial stenosis or occlusion (n=110). High systolic blood pressure successive variation (SV > 75%) vs. Lowest quartile of successive variation (SV < 25%) was evaluated on Poor functional outcome at 3 months (mRS ≥ 2) (OR 8.676, 95% CI 1.892-39.775, p=0.005). High systolic blood pressure successive variation within 24 hours of thrombolysis significantly increased the risk of poor 3-month outcome (OR 8.676) in acute ischemic stroke patients with SIASO.

synapsesocial.com/papers/6a774b62249abce98a1e6ce5 https://doi.org/10.21203/rs.3.rs-598417/v1

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Effects Of Early-Stage Blood Pressure Variability On The Functional Outcome In Acute Ischemic Stroke Patients With Symptomatic Intracranial Arterial Stenosis Or Occlusion Receiving Intravenous Thrombolysis

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Effects Of Early-Stage Blood Pressure Variability On The Functional Outcome In Acute Ischemic Stroke Patients With Symptomatic Intracranial Arterial Stenosis Or Occlusion Receiving Intravenous Thrombolysis

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider