Cerebral autoregulation and response to intravenous thrombolysis for acute ischemic stroke

Autor(es)

Nogueira, Ricardo C. ^{[1, 2]} ; Lam, Man Y. ^[3] ; Llwyd, Osian ^[3] ; Salinet, Angela S. M. ^[1] ; Bor-Seng-Shu, Edson ^[1] ; Panerai, Ronney B. ^{[3, 4]} ; Robinson, Thompson G. ^{[3, 4]}

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Hosp Clin, Sch Med, Neurol Dept, BR-01246904 Sao Paulo - Brazil

^[2] Hosp Nove de Julho, Dept Neurol, Sao Paulo - Brazil

^[3] Univ Leicester, Dept Cardiovasc Sci, Cerebral Haemodynam Ageing & Stroke Med Res Grp, Leicester LE2 7LX, Leics - England

^[4] Univ Leicester, NIHR Leicester Biomed Res Ctr, Leicester LE3 9QP, Leics - England

• Tipo de documento: Artigo Científico
• Fonte: SCIENTIFIC REPORTS; v. 10, n. 1 JUN 29 2020.
• Citações Web of Science: 0

Resumo

We hypothesized that knowledge of cerebral autoregulation (CA) status during recanalization therapies could guide further studies aimed at neuroprotection targeting penumbral tissue, especially in patients that do not respond to therapy. Thus, we assessed CA status of patients with acute ischemic stroke (AIS) during intravenous r-tPA therapy and associated CA with response to therapy. AIS patients eligible for intravenous r-tPA therapy were recruited. Cerebral blood flow velocities (transcranial Doppler) from middle cerebral artery and blood pressure (Finometer) were recorded to calculate the autoregulation index (ARI, as surrogate for CA). National Institute of Health Stroke Score was assessed and used to define responders to therapy (improvement of >= 4 points on NIHSS measured 24-48 h after therapy). CA was considered impaired if ARI<4. In 38 patients studied, compared to responders, non-responders had significantly lower ARI values (affected hemisphere: 5.0 vs. 3.6; unaffected hemisphere: 5.4 vs. 4.4, p=0.03) and more likely to have impaired CA (32% vs. 62%, p=0.02) during thrombolysis. In conclusion, CA during thrombolysis was impaired in patients who did not respond to therapy. This variable should be investigated as a predictor of the response to therapy and to subsequent neurological outcome. (AU)

• Processo FAPESP: 13/25953-0 - Autorregulação encefálica na fase aguda e subaguda do acidente vascular encefálico isquêmico em doentes submetidos a terapia trombolítica
• Beneficiário: Ricardo de Carvalho Nogueira
• Modalidade de apoio: Auxílio à Pesquisa - Regular