Lakatos Lehel-Barna, Bolognese Manuel, Österreich Mareike, Müller Martin, Karwacki Grzegorz Marek
Department of Neurology and Neurorehabilitation, Section Neuroradiology, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland.
Department of Radiology, Section Neuroradiology, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland.
Neurol Int. 2024 Nov 25;16(6):1636-1652. doi: 10.3390/neurolint16060119.
Blood pressure (BP) management is challenging in patients with acute ischemic supratentorial stroke undergoing recanalization therapy due to the lack of established guidelines. Assessing dynamic cerebral autoregulation (dCA) may address this need, as it is a bedside technique that evaluates the transfer function phase in the very low-frequency (VLF) range (0.02-0.07 Hz) between BP and cerebral blood flow velocity (CBFV) in the middle cerebral artery. This phase is a prognostically relevant parameter, with lower values associated with poorer outcomes. This study aimed to evaluate whether early cranial computed tomography perfusion (CTP) can predict this parameter.
In this retrospective study, 165 consecutive patients with hemispheric strokes who underwent recanalizing therapy were included (median age: 73 years; interquartile range (IQR) 60-80; women: 43 (26%)). The cohort comprised 91 patients treated with intravenous thrombolysis (IV-lysis) alone (median National Institute of Health Stroke Scale (NIHSS) score: 5; IQR 3-7) and 74 patients treated with mechanical thrombectomy (median NIHSS: 15; IQR 9-18). Regression analysis was performed to assess the relationship between pretreatment CTP-derived ischemic penumbra and core stroke volumes and the dCA VLF phase, as well as CBFV assessed within the first 72 h post-stroke event.
Pretreatment penumbra volume was a significant predictor of the VLF phase (adjusted r = 0.040; = -0.001, 95% confidence interval (CI): -0.0018 to -0.0002, = 0.02). Core infarct volume was a stronger predictor of CBFV (adjusted r = 0.082; = 0.205, 95% CI: 0.0968-0.3198; = 0.0003) compared to penumbra volume ( = 0.01). Additionally, in the low-frequency range (0.07-0.20 Hz), CBFV and BP were inversely related to the gain, an index of vascular tone.
CTP metrics appear to correlate with the outcome-relevant VLF phase and reactive hyperemic CBFV, which interact with BP to influence vascular tone and gain. These aspects of dCA could potentially guide BP management in patients with acute stroke undergoing recanalization therapy. However, further validation is required.
由于缺乏既定指南，对于接受再通治疗的急性缺血性幕上卒中患者，血压管理具有挑战性。评估动态脑自动调节功能（dCA）可能满足这一需求，因为它是一种床旁技术，可评估大脑中动脉血压与脑血流速度（CBFV）之间极低频（VLF，0.02 - 0.07Hz）范围内的传递函数相位。该相位是一个与预后相关的参数，值越低，预后越差。本研究旨在评估早期头颅计算机断层扫描灌注（CTP）是否能预测该参数。
在这项回顾性研究中，纳入了165例连续接受再通治疗的半球性卒中患者（中位年龄：73岁；四分位间距（IQR）60 - 80；女性：43例（26%））。该队列包括91例仅接受静脉溶栓（IV - 溶栓）治疗的患者（美国国立卫生研究院卒中量表（NIHSS）中位评分：5；IQR 3 - 7）和74例接受机械取栓治疗的患者（NIHSS中位评分：15；IQR 9 - 18）。进行回归分析以评估治疗前CTP衍生的缺血半暗带和核心卒中体积与dCA VLF相位之间的关系，以及卒中事件后72小时内评估的CBFV。
治疗前半暗带体积是VLF相位的显著预测因子（调整后r = 0.040；β = -0.001，95%置信区间（CI）：-0.0018至-0.0002，P = 0.02）。与半暗带体积（P = 0.01）相比，核心梗死体积是CBFV更强的预测因子（调整后r = 0.082；β = 0.205，95%CI：0.0968 - 0.3198；P = 0.0003）。此外，在低频范围（0.07 - 0.20Hz），CBFV和血压与增益呈负相关，增益是血管张力的一个指标。
CTP指标似乎与与预后相关的VLF相位和反应性充血性CBFV相关，它们与血压相互作用以影响血管张力和增益。dCA的这些方面可能潜在地指导接受再通治疗的急性卒中患者的血压管理。然而，需要进一步验证。
