J Stroke.  2017 May;19(2):222-228. 10.5853/jos.2016.01739.

Blood Pressure May Be Associated with Arterial Collateralization in Anterior Circulation Ischemic Stroke before Acute Reperfusion Therapy

Affiliations
  • 1Department of Neurology, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China.
  • 2Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. Bernard.yan@mh.org.au
  • 3Statistics and Decision Analysis, Florey Institute of Neuroscience and Mental Health, Parkville, Australia.
  • 4School of Mathematics and Geospatial Science, RMIT University, Melbourne, Australia.
  • 5Department of Radiology, Neurointervention Service, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.

Abstract

BACKGROUND AND PURPOSE
Leptomeningeal collaterals maintain arterial perfusion in acute arterial occlusion but may fluctuate subject to arterial blood pressure (ABP). We aim to investigate the relationship between ABP and collaterals as assessed by computer tomography (CT) perfusion in acute ischemic stroke.
METHODS
We retrospectively analyzed acute anterior circulation ischemic stroke patients with CT perfusion from 2009 to 2014. Collateral status using relative filling time delay (rFTD) determined by time delay of collateral-derived contrast opacification within the Sylvian fissure, from 0 seconds to unlimited count. The data were analyzed by zero-inflated negative binomial regression model including an appropriate interaction examining in the model in terms of occlusion location and onset-to-CT time (OCT).
RESULTS
Two hundred and seventy patients were included. We found that increment of 10 mm Hg in BP, the odds that a patient would have rFTD equal to 0 seconds increased by 27.9% in systolic BP (SBP) (p=0.001), by 73.9% in diastolic BP (DBP) (p<0.001) and by 68.5% in mean BP (MBP) (p<0.001). For patients with rFTD not necessarily equal to 0 seconds, every 10 mm Hg increase in BP, there was a 7% decrease in expected count of seconds for rFTD in SBP (p=0.002), 10% decrease for rFTD in DBP and 11% decrease for rFTD in MBP. The arterial occlusion location and OCT showed no significant interaction in the BP-rFTD relationship (p>0.05).
CONCLUSIONS
In acute ischemic stroke, higher ABP is possibly associated with improved leptomeningeal collaterals as identified by decreased rFTD.

Keyword

Acute ischemic stroke; Blood pressure; Collaterals; Computed tomography perfusion; Recanalization

MeSH Terms

Arterial Pressure
Blood Pressure*
Humans
Perfusion
Reperfusion*
Retrospective Studies
Stroke*
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