Τίτλος:
Association of pretreatment blood pressure with tissue plasminogen
activator-induced arterial recanalization in acute ischemic stroke
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background and Purpose - Elevated systolic blood pressure (SBP) and lack
of early vessel recanalization are predictors of poor outcome among
patients with stroke treated with systemic tissue plasminogen activator
(tPA). We aimed to evaluate the potential relationship between
pretreatment SBP and tPA-induced recanalization.
Methods - Consecutive patients with acute ischemic stroke resulting from
intracranial artery occlusion were treated with standard intravenous tPA
and assessed with 2-MHz transcranial Doppler for arterial
recanalization. Early arterial recanalization was determined with
previously validated Thrombolysis in Brain Ischemia flow grading system
at 120 minutes after tPA bolus. Functional outcome at 3 months was
evaluated using the modified Rankin Scale.
Results - A total of 351 patients received intravenous tPA ( mean age:
68.7 +/- 13.4 years, median National Institutes of Health Stroke Scale
score 16.5). Patients with complete recanalization (n = 94) had lower
mean pretreatment SBP values ( 152 +/- 23 mm Hg) than patients with
incomplete or absent recanalization ( n = 257, 160 +/- 22 mm Hg, P =
0.010). Pretreatment SBP levels were inversely associated with complete
recanalization ( OR per 10-mm Hg increase: 0.85; 95% CI: 0.74 to 0.98,
P = 0.022) after adjustment for demographics, risk factors, stroke
severity, pretreatment Thrombolysis in Brain Ischemia grades, and
continuous versus intermittent exposure to transcranial Doppler.
Although patients with poor functional 3-month outcomes ( modified
Rankin Scale > 2) had higher pretreatment SBP values ( 160 +/- 25 mm Hg)
than functionally independent patients ( 154 +/- 20 mm Hg, P = 0.027),
pretreatment SBP levels were not independently associated with
functional outcome on multivariable analysis. Age, complete
recanalization, baseline National Institutes of Health Stroke Scale
score, and time from symptom onset to tPA bolus were independent ( P <
0.05) predictors of 3-month outcome.
Conclusion - Higher pretreatment SBP levels are associated with poor
recanalization in patients with acute stroke treated with intravenous
tPA.
Συγγραφείς:
Tsivgoulis, Georgios
Saqqur, Maher
Sharma, Vijay K.
Lao,
Annabelle Y.
Hill, Michael D.
Alexandrov, Andrei V.
CLOTBUST
Investigators
Εκδότης:
Lippincott, Williams & Wilkins
Λέξεις-κλειδιά:
blood pressure; outcome; recanalization; stroke; thrombolysis
DOI:
10.1161/01.STR.0000257314.74853.2b
