Blood Pressure May Be Associated with Arterial Collateralization in Anterior Circulation Ischemic Stroke before Acute Reperfusion Therapy
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Background and Purpose Leptomeningeal collaterals maintain arterial perfusion in acute arterialocclusion but may fluctuate subject to arterial blood pressure (ABP). We aim to investigate therelationship between ABP and collaterals as assessed by computer tomography (CT) perfusion inacute ischemic stroke. Methods We retrospectively analyzed acute anterior circulation ischemic stroke patients with CTperfusion from 2009 to 2014. Collateral status using relative filling time delay (rFTD) determined bytime delay of collateral-derived contrast opacification within the Sylvian fissure, from 0 seconds tounlimited count. The data were analyzed by zero-inflated negative binomial regression modelincluding an appropriate interaction examining in the model in terms of occlusion location andonset-to-CT time (OCT). Results Two hundred and seventy patients were included. We found that increment of 10 mm Hgin BP, the odds that a patient would have rFTD equal to 0 seconds increased by 27.9% in systolicBP (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 inBP, there was a 7% decrease in expected count of seconds for rFTD in SBP (P=0.002), 10% decreasefor rFTD in DBP and 11% decrease for rFTD in MBP. The arterial occlusion location and OCT showedno significant interaction in the BP-rFTD relationship (P>0.05). Conclusions In acute ischemic stroke, higher ABP is possibly associated with improvedleptomeningeal collaterals as identified by decreased rFTD.
Abstract
Background and Purpose Leptomeningeal collaterals maintain arterial perfusion in acute arterialocclusion but may fluctuate subject to arterial blood pressure (ABP). We aim to investigate therelationship between ABP and collaterals as assessed by computer tomography (CT) perfusion inacute ischemic stroke. Methods We retrospectively analyzed acute anterior circulation ischemic stroke patients with CTperfusion from 2009 to 2014. Collateral status using relative filling time delay (rFTD) determined bytime delay of collateral-derived contrast opacification within the Sylvian fissure, from 0 seconds tounlimited count. The data were analyzed by zero-inflated negative binomial regression modelincluding an appropriate interaction examining in the model in terms of occlusion location andonset-to-CT time (OCT). Results Two hundred and seventy patients were included. We found that increment of 10 mm Hgin BP, the odds that a patient would have rFTD equal to 0 seconds increased by 27.9% in systolicBP (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 inBP, there was a 7% decrease in expected count of seconds for rFTD in SBP (P=0.002), 10% decreasefor rFTD in DBP and 11% decrease for rFTD in MBP. The arterial occlusion location and OCT showedno significant interaction in the BP-rFTD relationship (P>0.05). Conclusions In acute ischemic stroke, higher ABP is possibly associated with improvedleptomeningeal collaterals as identified by decreased rFTD.
참고문헌 (36)
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