Abstract
BackgroundEndovascular 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.MethodsAIS 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.ResultsA 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.ConclusionIn 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.
Highlights
Endovascular therapy (EVT) is increasingly used to improve cerebral reperfusion after moderate-tosevere acute ischemic stroke (AIS)
EVT decisions were based on the National Institutes of Health Stroke Scale (NIHSS) score, occlusion site according to magnetic resonance angiography (MRA), and Arterial Spin Labeling (ASL) mismatch
Participant characteristics In 71 AIS patients, 2 cases were EVT failure, 2 cases were diagnosed as cancer, and 5 cases refused to receive EVT
Summary
Endovascular therapy (EVT) is increasingly used to improve cerebral reperfusion after moderate-tosevere acute ischemic stroke (AIS). Dynamic cerebral autoregulation (dCA) is an important brain reserve mechanism and is impaired after AIS. Dynamic cerebral autoregulation (dCA) is a pivotal mechanism to maintain stable cerebral hemodynamics [11]. Tian et al BMC Neurology (2020) 20:189 It is regarded as an intrinsic protective mechanism of the brain, which ensures relatively constant cerebral blood flow (CBF) despite fluctuations in arterial blood pressure (ABP) or cerebral perfusion pressure [12]. That means under pathological conditions that dCA was dysfunctional, CBF tends to passively vary with changes in ABP, leading to brain edema, intracranial hypertension, and consequential deterioration of neurological functions and clinical outcomes [14]. If the correlation between dCA and outcome is established, dCA may be used as an early hemodynamic marker to guide early management in patients who received EVT
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