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Abstract Details

Blood Pressure Management Outside Individualized Limits of Autoregulation is Associated with Neurologic Deterioration and Worse Functional Outcomes in Patients with Large-Vessel Occlusion (LVO) Ischemic Stroke
Cerebrovascular Disease and Interventional Neurology
S52 - Acute Non-Interventional Stroke Care (3:41 PM-3:52 PM)
002

Effective BP management after EVT is critical for maintaining optimal cerebral perfusion and protecting the brain from harmful hypo- or hyperperfusion. How to best manage BP during the early stages of LVO stroke remains uncertain, as a single, universal BP target below 180/105 mmHg is likely inadequate in this highly heterogeneous patient population. 

To determine individualized, autoregulation-based blood pressure (BP) targets for patients with LVO stroke undergoing endovascular therapy (EVT), and to assess how exceeding limits of autoregulation (LA) relates to neurologic worsening and functional outcome. 

We prospectively enrolled 52 patients with LVO stroke undergoing EVT. Autoregulatory function was continuously measured by interrogating changes in near-infrared spectroscopy derived tissue-oxygenation and mean arterial pressure (MAP). The resulting autoregulatory index was used to identify and trend the BP range at which autoregulation was most preserved. The percent time that MAP exceeded the upper and lower limit of autoregulation was calculated for each patient. Neurologic worsening was defined as an increase of 4 points in the NIHSS during the first 24hrs. Functional outcome was assessed using the modified Rankin Scale (mRS). Associations among percent time outside LA, neurologic worsening, and mRS were assessed using binary and ordinal logistic regression, adjusting for age, sex, TICI score, baseline NIHSS and ASPECTS.

Personalized LA were computed in all patients (age 70±15, 22F, mean NIHSS 14±6, monitoring time 25±12 hours, neurologic worsening=14). Optimal blood pressure and LA were calculated for 87±10% of the total monitoring period. Percent time with MAP outside limits of autoregulation was significantly associated with neurologic deterioration (p=0.017) and worse functional outcome at discharge (p=0.031) and 90 days (p=0.01).

Non-invasive determination of personalized BP thresholds for stroke patients is feasible. Exceeding individualized limits of autoregulation may increase the risk of neurologic worsening and poor functional outcomes.

Authors/Disclosures

PRESENTER
No disclosure on file
Anson Wang, MD (Massachusetts General Hospital) Dr. Wang has nothing to disclose.
Sumita M. Strander Ms. Strander has nothing to disclose.
Sreeja Kodali Ms. Kodali has nothing to disclose.
Lauren H. Sansing, MD Dr. Sansing has nothing to disclose.
Joseph Schindler, MD (Yale University Department of Neurology) Dr. Schindler has received personal compensation for serving as an employee of Aeromics. Dr. Schindler has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for Aeromics. Dr. Schindler has received stock or an ownership interest from Aeromics. Dr. Schindler has received publishing royalties from a publication relating to health care.
Emily J. Gilmore, MD (Yale University School of Medicine) Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care) Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Nils Petersen, MD (Yale University) The institution of Dr. Petersen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Silkroad Medical. Dr. Petersen has received research support from NIH.