Dynamic Cerebral Autoregulation Post Endovascular Thrombectomy in Acute Ischemic Stroke.

Faheem Sheriff,Mariel Kozberg,Sameen Jafari,Can Ozan Tan,Steven Feske,Fadar Oliver Otite,Shyam Rao,Elsa Azevedo,Farzaneh Sorond,Andrew Monk,Pedro Castro,Henrikas Vaitkevicius,Karen Li,Sarah Larose,Ayaz Khawaja

doi:10.3390/brainsci10090641

Abstract

The development of the endovascular thrombectomy (EVT) technique has revolutionized acute stroke management for patients with large vessel occlusions (LVOs). The impact of successful recanalization using an EVT on autoregulatory profiles is unknown. A more complete understanding of cerebral autoregulation in the context of EVT may assist with post-procedure hemodynamic optimization to prevent complications. We examined cerebral autoregulation in 107 patients with an LVO in the anterior circulation (proximal middle cerebral artery (M1/2) and internal cerebral artery (ICA) terminus) who had been treated using an EVT. Dynamic cerebral autoregulation was assessed at multiple time points, ranging from less than 24 h to 5 days following last seen well (LSW) time, using transcranial Doppler ultrasound recordings and transfer function analysis. Complete (Thrombolysis in Cerebral Infarction (TICI) 3) recanalization was associated with a more favorable autoregulation profile compared with TICI 2b or poorer recanalization (p < 0.05), which is an effect that was present after accounting for differences in the infarct volumes. Less effective autoregulation in the first 24 h following the LSW time was associated with increased rates of parenchymal hematoma types 1 and 2 hemorrhagic transformations (PH1–PH2). These data suggest that patients with incomplete recanalization and poor autoregulation (especially within the first 24 h post-LSW time) may warrant closer blood pressure monitoring and control in the first few days post ictus.

Highlights

Acute stroke management has improved dramatically over the past few years, with the development of the endovascular thrombectomy (EVT) technique for large vessel occlusion (LVO)strokes [1,2,3,4,5]
Adult patients with a large vessel occlusion in the anterior circulation (including the proximal middle cerebral artery (M1/2) and the internal cerebral artery (ICA) terminus), with a National Institutes of Health Stroke Scale (NIHSS) score ≥6 at any time within 72 h of the last seen well (LSW) time who underwent endovascular thrombectomy were eligible for the study
Patients were age-matched across both groups, with no significant differences in the baseline stroke characteristics, tissue plasminogen activator administration, the Alberta Stroke Program Early

Summary

Introduction

Acute stroke management has improved dramatically over the past few years, with the development of the endovascular thrombectomy (EVT) technique for large vessel occlusion (LVO)strokes [1,2,3,4,5]. Cerebral autoregulation is the ability of cerebral vasculature to maintain stable cerebral blood flow despite fluctuations in the systemic blood pressure through modulation of the cerebrovascular tone [8,9]. Post-stroke impairment in autoregulation has been associated with poor outcomes, including larger infarct volumes and increased rates of hemorrhagic conversion. These impairments are prominent within the first five days post stroke [10,11], and appear to be global, affecting both the ipsilateral and the contralateral hemispheres [8,9,10,11,12,13,14,15]

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