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Abstract Details

Poor Collaterals and Malignant CT Perfusion Profiles Are Associated with Increased Vulnerability to Blood Pressure Reductions during Endovascular Therapy
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (11:30 AM-1:00 PM)
15-034

After large-vessel occlusion (LVO), blood flow to the ischemic penumbra largely depends on collateral perfusion. Intraprocedural BP reductions have been associated with infarct growth and unfavorable functional outcome. We hypothesized that patients with poor collateral circulation assessed using CT perfusion and CTA imaging are at increased risk for infarct progression associated with intraprocedural BP reductions.

To examine the relationship between poor collateral circulation and sensitivity to blood pressure (BP) reductions during endovascular therapy (EVT).

We prospectively enrolled 111 patients with LVO stroke who underwent EVT at two comprehensive stroke centers. Volumes of arterial tissue delay >10 seconds (ATD10) were estimated with RAPID software; in accordance with previous studies, malignant perfusion profile was defined as ADT10 >100 ml. Collaterals were independently scored on CTA images using the Miteff and rLMC systems. BP reduction was defined as the difference between admission BP and lowest intraprocedural BP; both systolic blood pressure (SBP) and mean arterial pressure (MAP) reductions were measured. Infarct progression was defined as the difference between follow-up MRI infarct volume and RAPID-assessed CBF<30% core infarct volume.

Seventy-nine patients (mean age 69±14, 47F, mean NIHSS 16) who were successfully revascularized (TICI 2B/3) were included in analysis. Mean baseline MAP was 106±19 mmHg; median MAP reduction was 21 (IQR 5-37). Malignant perfusion profile (n=21) was an independent predictor of infarct progression after adjusting for age, sex, admission NIHSS, and time to EVT (mean 40 vs. 22 ml, p=0.019). A significant interaction was found between SBP reduction and both malignant profile (p=0.01) and collateral status (p=0.03, Miteff; p=0.07, rLMC). For every 10 mmHg MAP reduction, patients with poor versus excellent collaterals experienced an average infarct growth of 7 ml versus 1 ml, respectively.

Patients with malignant perfusion profiles and poor collaterals are at significantly higher risk of infarct progression related to intraprocedural BP reduction.

Authors/Disclosures
Sumita M. Strander
PRESENTER
Ms. Strander has nothing to disclose.
No disclosure on file
Anson Wang, MD (Massachusetts General Hospital) Dr. Wang has nothing to disclose.
Sreeja Kodali Ms. Kodali has nothing to disclose.
No disclosure on file
Tijil Agarwal, MD Dr. Agarwal has nothing to disclose.
Christoph Stretz, MD, FAAN (Rhode Island Hospital, Department of Neurology) Dr. Stretz has nothing to disclose.
No disclosure on file
Gloria V. Lopez Cardenas, MD No disclosure on file
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.
Charles Matouk Charles Matouk has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Silk Road Medical. Charles Matouk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Charles Matouk has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Navigantis.
Ryan Hebert Ryan Hebert has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus .
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.
Santiago Ortega Gutierrez, MD (University of Iowa) Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH. The institution of Dr. Ortega Gutierrez has received research support from PCORI.
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.