Department of Neurology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
Ann Neurol. 2019 Mar;85(3):331-339. doi: 10.1002/ana.25428. Epub 2019 Feb 18.
To explore the association of poststroke baseline blood pressure with cerebral collateral flow and functional outcome in acute ischemic patients with large vessel occlusion/stenosis.
Patients identified with large vessel occlusion/stenosis with baseline multimodal computed tomography, follow-up imaging, and complete clinical profiles were included. A 90-day modified Rankin Scale of 0-1 was defined as an excellent functional outcome. Cerebral collateral flow was quantified by the volume ratio of tissue within the delay time >3 seconds perfusion lesion with severely delayed contrast transit (delay time >3 seconds/delay time >6 seconds).
There were 306 patients included in this study. With every increase of 10 mmHg in baseline systolic blood pressure, the odds of achieving an excellent functional outcome decreased by 12% in multivariate analysis (odds ratio = 0.88, p = 0.048). Conversely, increased baseline blood pressure was associated with better collateral flow. In subgroup analysis of patients with major reperfusion, higher blood pressure was associated with decreased infarct growth and a better clinical outcome, and vice versa in patients without reperfusion.
Higher baseline blood pressure in acute ischemic stroke patients with large vessel occlusion/stenosis was associated with better collateral flow. However, for patients without reperfusion, higher baseline blood pressure was associated with increased infarct growth, leading to an unfavorable clinical outcome. The relationship between blood pressure and outcomes is highly dependent on reperfusion, and active blood pressure-lowering treatment may be inappropriate in acute ischemic stroke patients prior to reperfusion treatment. ANN NEUROL 2019;85:331-339.
探讨急性大血管闭塞/狭窄缺血性脑卒中患者基线血压与脑侧支循环及功能结局的关系。
本研究纳入基线多模态 CT、随访影像和完整临床特征的大血管闭塞/狭窄患者。90 天改良 Rankin 量表评分 0-1 定义为功能结局良好。脑侧支循环通过严重延迟对比剂通过时间（延迟时间>3 秒/延迟时间>6 秒）的组织与延迟时间>3 秒灌注病变的体积比来定量。
本研究共纳入 306 例患者。多变量分析显示，基线收缩压每增加 10mmHg，功能结局良好的几率降低 12%（比值比=0.88，p=0.048）。相反，基线血压升高与更好的侧支循环相关。在主要再灌注患者的亚组分析中，较高的血压与梗死体积减小和更好的临床结局相关，而在无再灌注的患者中则相反。
急性大血管闭塞/狭窄缺血性脑卒中患者基线血压较高与更好的侧支循环相关。然而，对于无再灌注的患者，较高的基线血压与梗死体积增大相关，导致临床结局不良。血压与结局之间的关系高度依赖于再灌注，在再灌注治疗前，急性缺血性脑卒中患者积极降压治疗可能不合适。
