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BMC Neurology

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01-12-2020 | Stroke | Research article

Dynamic cerebral autoregulation is an independent outcome predictor of acute ischemic stroke after endovascular therapy

Authors: Ge Tian, Zhong Ji, Kaibin Huang, Zhenzhou Lin, Suyue Pan, Yongming Wu

Published in: BMC Neurology | Issue 1/2020

Abstract

Background

Endovascular therapy (EVT) is increasingly used to improve cerebral reperfusion after moderate-to-severe acute ischemic stroke (AIS). However, the influence of hemodynamic factors on clinical outcome is still unclear after EVT. Dynamic cerebral autoregulation (dCA) is an important brain reserve mechanism and is impaired after AIS. This study aimed to explore the role of dCA in predicting the outcome of AIS patients after EVT.

Methods

AIS patients with severe stenosis/occlusion of unilateral middle cerebral artery (MCA) or internal carotid and treatment with EVT were enrolled to receive dCA examinations at the 24 h, 72 h and 7th day after stroke onset. Healthy volunteers were also recruited as controls. DCA was recorded from spontaneous fluctuations of blood pressure and MCA flow velocity. Transfer function analysis was used to derive dCA parameters, including phase difference (PD) and coherence in the low-frequency range (0.06–0.12 Hz). The clinical outcome was measured using the modified Rankin Scale (mRS) at 90 days after onset. Multivariate logistic regression was performed to reveal the correlation between dCA and clinical outcomes. The receiver operation characteristics (ROC) curve was performed to determine the cut-off point of PD.

Results

A total of 62 AIS patients and 77 healthy controls were included. Compared with controls, dCA were impaired bilaterally till to 7th day after onset in patients, presenting as much lower PD value on the ipsilateral side. During follow-up, we found that PD on the ipsilateral side at 24 h after onset was significantly lower in patients with unfavourable outcome (n = 41) than those with favourable outcome (n = 21), even after adjustment of confounding factors (p = 0.009). ROC curve analysis revealed that PD < 26.93° was an independent predictor of unfavourable-outcome.

Conclusion

In AIS patients after EVT, dCA was impaired on both sides over the first 7 days. PD on the ipsilateral side at 24 h after onset is an independent unfavourable-outcome predictor for AIS after EVT.

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Title: Dynamic cerebral autoregulation is an independent outcome predictor of acute ischemic stroke after endovascular therapy
Authors: Ge Tian
Zhong Ji
Kaibin Huang
Zhenzhou Lin
Suyue Pan
Yongming Wu
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Stroke
Published in: BMC Neurology / Issue 1/2020
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-020-01737-w

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Springer Medicine

Dynamic cerebral autoregulation is an independent outcome predictor of acute ischemic stroke after endovascular therapy

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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