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01-04-2019 | Stroke | Original Communication

Early microvascular cerebral blood flow response to head-of-bed elevation is related to outcome in acute ischemic stroke

Authors: Clara Gregori-Pla, Igor Blanco, Pol Camps-Renom, Peyman Zirak, Isabel Serra, Gianluca Cotta, Federica Maruccia, Luís Prats-Sánchez, Alejandro Martínez-Domeño, David R. Busch, Giacomo Giacalone, Joan Martí-Fàbregas, Turgut Durduran, Raquel Delgado-Mederos

Published in: Journal of Neurology | Issue 4/2019

Abstract

Background and aims

Previously, microvascular cerebral blood flow (CBF) response to a mild head-of-bed (HOB) elevation has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS). We have hypothesized that early CBF response is related to the functional outcome.

Methods

Patients with a non-lacunar AIS in the anterior circulation were monitored by DCS to measure relative CBF (ΔrCBF) on the frontal lobes bilaterally during a 0°–30° HOB elevation at early (≤ 12) or late (> 12) hours from symptom onset. National Institutes of Health Stroke Scale (NIHSS) scores were recorded at baseline at 24 and at 48 h. Functional outcome was measured by the modified Rankin Scale (mRS) at 3 months.

Results

Thirty-eight (n = 38) AIS patients [baseline NIHSS = 19 (interquartile range: 16, 21)] were studied. ΔrCBF decreased similarly in both hemispheres (p = 0.4) when HOB was elevated and was not associated with baseline and follow-up NIHSS scores or patient demographics. At the early phase (n = 17), a lower or paradoxical ΔrCBF response to HOB elevation was associated with an unfavorable functional outcome (mRS > 2) in the ipsilesional (but not in the contralesional) hemisphere (p = 0.010). ΔrCBF response in the late acute phase was not related to mRS.

Conclusions

Early CBF response to mild HOB elevation in the ipsilesional hemisphere is related to functional outcome. Further studies may enable optical monitoring at the bedside to individualize management strategies in the early phase of AIS.

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Title: Early microvascular cerebral blood flow response to head-of-bed elevation is related to outcome in acute ischemic stroke
Authors: Clara Gregori-Pla
Igor Blanco
Pol Camps-Renom
Peyman Zirak
Isabel Serra
Gianluca Cotta
Federica Maruccia
Luís Prats-Sánchez
Alejandro Martínez-Domeño
David R. Busch
Giacomo Giacalone
Joan Martí-Fàbregas
Turgut Durduran
Raquel Delgado-Mederos
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Keyword: Stroke
Published in: Journal of Neurology / Issue 4/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09226-y

At a glance: The STEP trials

Springer Medicine

Early microvascular cerebral blood flow response to head-of-bed elevation is related to outcome in acute ischemic stroke

Abstract

Background and aims

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background and aims

Methods

Results

Conclusions

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