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Dynamic Cerebral Autoregulation Post Endovascular Thrombectomy in Acute Ischemic Stroke
Faheem Sheriff1,2,3, Pedro Castro4,5, Mariel Kozberg1,2
1Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Brain Sciences
|September 19, 2020
Summary
Successful endovascular thrombectomy (EVT) for large vessel occlusions (LVOs) improves cerebral autoregulation. Poor autoregulation post-EVT, especially within 24 hours, increases risks of hemorrhagic transformations, necessitating close blood pressure management.
Area of Science:
- Neurology
- Vascular Neurology
- Interventional Neurology
Background:
- Endovascular thrombectomy (EVT) has transformed acute stroke care for large vessel occlusions (LVOs).
- The effect of successful EVT recanalization on cerebral autoregulation remains unclear.
- Understanding post-EVT autoregulation is crucial for hemodynamic optimization and complication prevention.
Purpose of the Study:
- To investigate cerebral autoregulation profiles following EVT in patients with anterior circulation LVOs.
- To determine the association between recanalization success and autoregulation.
- To explore the relationship between autoregulation and post-procedural hemorrhagic transformations.
Main Methods:
- Assessed dynamic cerebral autoregulation in 107 LVO patients treated with EVT.
- Utilized transcranial Doppler ultrasound and transfer function analysis at multiple time points post-procedure.
- Correlated autoregulation status with recanalization grades (TICI 3 vs. TICI 2b or poorer) and infarct volumes.
Main Results:
- Complete recanalization (TICI 3) correlated with significantly better autoregulation compared to TICI 2b or poorer.
- Less effective autoregulation within 24 hours of last seen well (LSW) time was linked to higher rates of parenchymal hematoma (PH1-PH2).
- These associations persisted even after controlling for infarct volume.
Conclusions:
- Successful EVT is associated with improved cerebral autoregulation.
- Impaired autoregulation post-EVT, particularly early on, predicts increased risk of hemorrhagic transformation.
- Patients with incomplete recanalization and poor early autoregulation require vigilant blood pressure management post-stroke.
