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Fixed Compared With Autoregulation-Oriented Blood Pressure Thresholds After Mechanical Thrombectomy for Ischemic
Nils H Petersen1, Andrew Silverman1, Sumita M Strander1
1From the Department of Neurology (N.H.P., A.S., S.M.S., S.K., A.W., L.H.S., J.L.S., G.J.F., E.J.G., A.S.J., K.N.S.), Yale University School of Medicine, New Haven, CT.
Stroke
|February 21, 2020
Summary
Personalized blood pressure (BP) targets, based on cerebral autoregulation, improve outcomes for stroke patients after endovascular thrombectomy. Deviating from these individual BP limits increases the risk of brain injury and poor functional outcomes.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Biomedical Engineering
Background:
- Cerebral autoregulation is crucial for maintaining brain blood flow during ischemic stroke.
- Loss of autoregulation post-thrombectomy makes patients vulnerable to blood pressure fluctuations.
- Optimizing blood pressure management is vital to prevent hypoperfusion or hyperperfusion injuries.
Purpose of the Study:
- To compare personalized, autoregulation-based blood pressure targets with static systolic blood pressure thresholds.
- To assess the feasibility of noninvasively determining personalized blood pressure limits after endovascular thrombectomy.
- To investigate the association between blood pressure management strategies and functional outcomes in stroke patients.
Main Methods:
- Prospective enrollment of 90 patients undergoing endovascular thrombectomy for stroke.
- Continuous monitoring of autoregulatory function using near-infrared spectroscopy and mean arterial pressure.
- Calculation of time spent outside personalized autoregulation limits and fixed systolic blood pressure thresholds.
- Assessment of functional outcome using the modified Rankin Scale at 90 days.
Main Results:
- Personalized autoregulation limits were successfully computed for all patients.
- Increased time with mean arterial pressure above the upper autoregulation limit correlated with worse 90-day functional outcomes.
- Patients with hemorrhagic transformation spent significantly more time above their upper autoregulation limit.
- Static systolic blood pressure thresholds showed a weaker association with outcomes compared to personalized limits.
Conclusions:
- Noninvasive determination of personalized blood pressure thresholds in stroke patients is feasible.
- Exceeding personalized autoregulation limits may increase the risk of secondary brain injury and adverse functional outcomes.
- An autoregulation-based approach to blood pressure management may offer superior outcomes compared to fixed thresholds, warranting further randomized trials.
