Delgado-Mederos R, Ribo M, Rovira A, Rubiera M, Munuera J, Santamarina E, Delgado P, Maisterra O, Alvarez-Sabin J, Molina C A
Brain Hemodynamics Lab, Neurovascular Unit, Department of Neurology, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Neurology. 2008 Aug 19;71(8):552-8. doi: 10.1212/01.wnl.0000318294.36223.69. Epub 2008 Jun 11.
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).
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.
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.
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.
评估早期血压（BP）变化对接受静脉注射组织型纤溶酶原激活剂（tPA）治疗的中风患者弥散加权成像（DWI）病变演变及临床结局的影响。
我们前瞻性评估了80例记录有大脑中动脉闭塞且接受静脉tPA治疗的中风患者。入院后24小时内多次重复测量收缩压（SBP）和舒张压（DBP）。所有患者在溶栓前及溶栓后36 - 48小时均接受了DWI、灌注加权成像和磁共振血管造影检查。在中风发作6小时时通过经颅多普勒评估再通情况。在基线和24小时记录美国国立卫生研究院卒中量表评分。采用改良Rankin量表评估3个月时的结局。
44例（55%）患者实现再通。以均值标准差估计的血压变异性与DWI病变增长相关（SBP的r = 0.46，p = 0.0003；DBP的r = 0.26，p = 0.02）、早期临床病程相关（SBP的p = 0.06，DBP的p = 0.01）以及3个月时的结局相关（SBP的p = 0.002，DBP的p = 0.07）。然而，血压变化的预后意义因是否再通而有所不同。在未实现再通的患者中，SBP变异性成为DWI病变增长（β：6.9；95%可信区间，3.2至10.7，p = 0.003）和更差中风结局（比值比：11；95%可信区间：2.2至56.1；p = 0.004）的独立预测因素，但在已再通的患者中并非如此。
在接受静脉注射组织型纤溶酶原激活剂治疗的中风患者中，血压变异性与更大的弥散加权成像病变增长及更差的临床病程相关。然而，其影响因溶栓后早期再通的发生情况而异。
