Early microvascular cerebral blood flow response to head-of-bed elevation is related to outcome in acute ischemic stroke
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.
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.
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.
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.
KeywordsIschemic stroke Outcome Cerebral blood flow Brain perfusion Diffuse correlation spectroscopy Near-infrared spectroscopy
This work was funded by Redes Temáticas de Investigación Cooperativa (RETICS-INVICTUS RD012/0014, RD16/0019/0010), Fundació CELLEX Barcelona, Ministerio de Economía y Competitividad/FEDER (PHOTODEMENTIA, DPI2015-64358-C2-1-R), ISCIII/FEDER (MEDPHOTAGE, DTS16/00087, FIS-PI09/0557, FIS2015-71851-P), “Severo Ochoa” Programme (SEV-2015-0522), Obra Social “la Caixa” (LlumMedBcn, Recerca Matemàtica Col·laborativa), Institució Centres de Recerca de Catalunya, Agència de Gestió d’Ajuts Universitaris i de Recerca (2017SGR-1380, 2014SGR-1307), LASERLAB-EUROPE IV (EU-H2020-654148), Whitaker International, T32 HL007954 Multidisciplinary training in cardiovascular biology, “Fundació La Marató TV3” (201709.31) and Marie Curie Initial Training Network (OILTEBIA/317526).
Compliance with standards
Conflicts of interest
ICFO has equity ownership in HemoPhotonics S.L. commercializing relevant technologies. Potential financial conflicts of interest and objectivity of research have been monitored by ICFO Knowledge & Technology Transfer Department and none were identified.
All human studies have been approved by the appropriate ethics committee (EC/15/130) and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
- 1.Powers WJ, Rabinstein AA, Ackerson T et al (2018) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49(3): e46–e110. https://doi.org/10.1161/STR.0000000000000158.1608.04207 CrossRefGoogle Scholar
- 2.Powers WJ, Derdeyn CP, Biller J et al (2015) American Heart Association/American stroke association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46(10):3020–3035. https://doi.org/10.1161/STR.0000000000000074 CrossRefGoogle Scholar
- 14.Kim MN, Edlow BL, Durduran T et al (2014) Continuous optical monitoring of cerebral hemodynamics during head-of-bed manipulation in brain-injured adults. Neurocrit Care 20(3):443–453. https://doi.org/10.1007/s12028-_013-_9849-_7.Continuous CrossRefGoogle Scholar
- 18.Gregori-Pla C, Cotta G, Camps-Renom P et al (2017) Brain. cereb. blood flow, metab. funct. International Society for Cerebral Blood Flow and Metabolism, BerlinGoogle Scholar
- 19.R Core Team (2015) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, AustriaGoogle Scholar
- 24.Ropper A, O’Rourke D, Kennedy S (1982) Prevalence and risk factors associated with reversed Robin Hood syndrome in acute ischemic stroke. Neurology 11(32):128–129Google Scholar