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Cerebral hemodynamics in stroke thrombolysis (CHiST) study.

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journal contribution
posted on 29.07.2021, 11:00 by Man Y Lam, Victoria J Haunton, Ronney B Panerai, Thompson G Robinson
Despite careful patient selection, successful recanalization in intravenous thrombolysis is only achieved in approximately 50% of cases. Understanding changes in cerebral autoregulation during and following successful recanalization in acute ischemic stroke patients who receive intravenous thrombolysis, may inform the management of common physiological perturbations, including blood pressure, in turn reducing the risk of reperfusion injury. Cerebral blood velocity (Transcranial Doppler), blood pressure (Finometer) and end-tidal carbon dioxide (capnography) were continuously recorded in 11 acute ischemic stroke patients who received intravenous thrombolysis (5 female, mean ± SD age 68±12 years) over 4-time points, during and at the following time intervals after intravenous thrombolysis: 23.9±2.6 hrs, 18.1±7.0 days and 89.6±4.2 days. Reductions in blood pressure (p = 0.04) were observed during intravenous thrombolysis. Reductions in heart rate (p<0.005) and critical closing pressure [Affected hemisphere (p = 0.02) and non-affected hemisphere (p<0.005)] were observed post intravenous thrombolysis. End-tidal CO2 increased during the sub-acute and chronic stages (p = 0.028). Reduction in affected hemisphere phase at low frequency was observed during intravenous thrombolysis (p = 0.021) and at subsequent visits (p = 0.048). No changes were observed in cerebral blood velocity, coherence, gain and Autoregulation Index during the follow-up period. Intravenous thrombolysis in acute ischemic stroke patients induced changes in affected hemisphere phase and other key hemodynamic parameters, but not Autoregulation Index. Further investigation of cerebral autoregulation is warranted in a larger acute ischemic stroke cohort to inform its potential role in individualized management plans.

History

Citation

Lam MY, Haunton VJ, Panerai RB, Robinson TG (2020) Cerebral hemodynamics in stroke thrombolysis (CHiST) study. PLoS ONE 15(9): e0238620. https://doi.org/10.1371/journal.pone.0238620

Author affiliation

Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

PloS one

Volume

15

Issue

9

Pagination

e0238620

Publisher

Public Library of Science

issn

1932-6203

eissn

1932-6203

Acceptance date

20/08/2020

Copyright date

2020

Available date

29/07/2021

Spatial coverage

United States

Language

eng