Bedoucha Laurine, Gobron Claire, Vallee Fabrice, Gayat Etienne, Reiner Peggy, Sabben Candice, Obadia Michael, Boursin Perrine, Dubus Estelle, Jouvent Eric, Mazighi Mikael, Di Meglio Lucas
Hôpital Lariboisière AP-HP, Université Paris Cité, FHU NeuroVasc, StrokeLink, Paris, France.
Service De Physiologie Clinique-Explorations Fonctionnelles, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Paris, France.
Brain Behav. 2025 Sep;15(9):e70901. doi: 10.1002/brb3.70901.
The optimal timing for mobilizing patients during the acute phase of ischemic stroke remains unclear. Prior research has produced conflicting results, often neglecting the impact of upstream arterial stenosis on cerebral blood flow. This study aimed to determine whether early transition to a seated position in the acute phase of ischemic stroke influences intracranial hemodynamics, particularly in patients with significant carotid stenosis.
In a prospective, bi-centric, 1:1 case-control observational study (NCT04180826), we continuously and non-invasively monitored cerebral and systemic hemodynamics during the first authorized transition from supine to a sitting position in patients with ischemic stroke of the carotid territory. Cases were defined as those with homolateral carotid stenosis >50% by NASCET criteria. The primary outcome was a >10% reduction in mean flow velocity (MFV) in the homolateral middle cerebral artery (MCA).
Of 42 screened patients, 36 were included (19 controls, 17 cases). A significant (>10%) MFV drop occurred in 9/17 cases (53%) versus 1/19 controls (5%; p = 0.012). Notably, cases with an MFV drop showed no compensatory systemic response (no rise in blood pressure or heart rate). Multivariate analysis revealed that a shorter time from stroke onset to sitting (coefficient = -2.793, p = 0.016) and being a case (coefficient = -6.283, p = 0.004) independently predicted an MFV decrease >10%. Additional factors associated with significant MFV decline in cases included the absence of a blood pressure increase after verticalization, lower hemoglobin (p = 0.007), and higher BNP levels (p = 0.024).
Early sitting in the acute phase of ischemic stroke is more frequently associated with marked MFV reductions in patients with carotid stenosis, potentially due to impaired systemic hemodynamic adaptation. These findings underscore the importance of individualized mobilization strategies based on vascular and systemic factors.
缺血性中风急性期患者活动的最佳时机仍不明确。先前的研究结果相互矛盾，且常常忽视上游动脉狭窄对脑血流的影响。本研究旨在确定缺血性中风急性期尽早转为坐姿是否会影响颅内血流动力学，尤其是在有严重颈动脉狭窄的患者中。
在一项前瞻性、双中心、1:1病例对照观察性研究（NCT04180826）中，我们在颈内动脉供血区缺血性中风患者首次经授权从仰卧位转为坐姿的过程中，持续且无创地监测脑和全身血流动力学。病例定义为符合北美症状性颈动脉内膜切除术（NASCET）标准、同侧颈动脉狭窄>50%的患者。主要结局是同侧大脑中动脉（MCA）平均血流速度（MFV）降低>10%。
在42例筛查患者中，36例被纳入研究（19例对照，17例病例）。17例病例中有9例（53%）出现显著（>10%）的MFV下降，而19例对照中只有1例（5%）出现下降（p = 0.012）。值得注意的是，出现MFV下降的病例未表现出系统性代偿反应（血压或心率未升高）。多变量分析显示，从中风发作到坐姿的时间较短（系数 = -2.793，p = 0.016）以及作为病例组（系数 = -6.283，p = 0.004）独立预测MFV下降>10%。病例组中与显著MFV下降相关的其他因素包括直立后血压未升高、血红蛋白水平较低（p = 0.007）和脑钠肽（BNP）水平较高（p = 0.024）。
缺血性中风急性期尽早坐姿在有颈动脉狭窄的患者中更常与显著的MFV降低相关，这可能是由于系统性血流动力学适应受损所致。这些发现强调了基于血管和全身因素制定个体化活动策略的重要性。
