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Blood pressure and collateral circulation in acute ischemic stroke

Blutdruck und Umgehungskreislauf bei akutem ischämischem Schlaganfall

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Abstract

Background

This study aimed to evaluate the effect of different blood pressure (BP) parameters on the collateral circulation in a retrospective cohort of patients with acute ischemic stroke and ipsilateral internal carotid artery (ICA) occlusion.

Methods

The degree of intracranial collaterals was graded according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) Collateral Flow Grading System. At 12–72 h after stroke onset, six BP measurements were obtained in 124 patients with ICA occlusion. Baseline clinical and imaging characteristics were collected. Group comparisons were performed, and the collateral score (CS) was assessed and entered into a logistic regression analysis.

Results

In all, 80 (64.5%) patients displayed good collateral filling (CS ≥ 2). Good intracranial collaterals were more frequently associated with the development of collaterals in the anterior communicating artery, posterior communicating artery, and leptomeningeal artery. The systolic blood pressure (SBP; p = 0.018), diastolic blood pressure (DBP; p = 0.013), and mean arterial pressure (MAP; p = 0.016) were significantly associated with good CS. Median CS was highest when SBP was 120–130 mm Hg (p = 0.034). Logistic regression analysis showed that hypertension (p = 0.026, OR: 0.380, 95% CI: 0.163–0.890) was a significant predictor of poor CS.

Conclusion

The development of collateral circulation in patients with acute ischemic stroke with ICA occlusion may be influenced by BP. A moderately decreased SBP is associated with good integrity of the collateral circulation in patients with acute ischemic stroke with occlusion of the ICA.

Zusammenfassung

Hintergrund

Die vorliegende Studie zielte darauf ab, die Wirkung verschiedener Parameter des Blutdrucks („blood pressure“, BP) auf den Umgehungskreislauf in einer retrospektiven Kohorte von Patienten mit akutem ischämischem Schlaganfall und ipsilateralem Verschluss der A. carotis interna („internal carotid artery“, ICA) zu untersuchen.

Methoden

Das Ausmaß intrakranieller Kollateralen wurde gemäß dem Klassifikationssystem für den Kollateralfluss, dem Collateral Flow Grading System der American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR), eingestuft. Zum Zeitpunkt 12–72 h nach Beginn des Schlaganfalls erfolgten 6 Blutdruckmessungen bei 124 Patienten mit ICA-Verschluss. Die klinischen und bildgebenden Ausgangsmerkmale wurden dokumentiert. Es wurde ein Gruppenvergleich durchgeführt, darüber hinaus wurde der Kollateralscore („collateral score“, CS) ermittelt und in die logistische Regressionsanalyse aufgenommen.

Ergebnisse

Insgesamt zeigte sich bei 80 (64,5%) Patienten eine gute Kollateralenfüllung (CS ≥ 2). Gute intrakranielle Kollateralen waren häufiger mit der Entwicklung von Kollateralen in der A. communicans anterior, der A. communicans posterior und der A. leptomeningealis assoziiert. Der systolische Blutdruck (SBP; p = 0,018), diastolische Blutdruck (DBP; p = 0,013) und der mittlere arterielle Druck („mean arterial pressure“, MAP; p = 0,016) waren signifikant mit einem guten CS korreliert. Der mediane CS war am höchsten, wenn der SBP 120–130 mm Hg (p = 0,034) betrug. Die logistische Regressionsanalyse zeigte, dass Hypertonie (p = 0,026; Odds Ratio, OR: 0,380; 95%-Konfidenzintervall, 95%-KI: 0,163–0,890) ein signifikanter Prädiktor eines schlechten CS war.

Schlussfolgerung

Die Entwicklung eines Umgehungskreislaufs bei Patienten mit akutem ischämischem Schlaganfall mit ICA-Verschluss wird möglicherweise durch den Blutdruck beeinflusst. Ein mäßig erniedrigter SBP ist mit einer guten Ausprägung des Kollateralkreislaufs bei Patienten mit akutem ischämischem Schlaganfall und Verschluss der ICA assoziiert.

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Authors and Affiliations

  1. Department of Neurology, The First Affiliated Hospital, Xinjiang Medical University, 830054, Urumqi, Xinjiang, China

    A. Wufuer, R. Abudusalamu, H. Dengfeng, C. Jian & M. Jianhua

  2. Department of Epidemiology and Biostatistics, School of Public Health, Xinjiang Medical University, 830011, Urumqi, Xinjiang, China

    P. Mijiti

  3. Department of Neurology, Traditional Chinese Medicine Hospital, Xinjiang Medical University, 830054, Urumqi, Xinjiang, China

    Z. Xiaoning

Authors
  1. A. Wufuer
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  2. P. Mijiti
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  3. R. Abudusalamu
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  4. H. Dengfeng
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  5. C. Jian
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  6. M. Jianhua
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  7. Z. Xiaoning
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Corresponding author

Correspondence to Z. Xiaoning.

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Conflict of interest

A. Wufuer, P. Mijiti, R. Abudusalamu, H. Dengfeng, C. Jian, M. Jianhua, and Z. Xiaoning declare that they have no competing interests.

This contribution depicts a retrospective study which does not interfere with therapy. The protocol was approved by the Xinjiang Medical University Ethics Committee and conducted in accordance with the Declaration of Helsinki. All patients gave written informed consent.

Additional information

Author contributions. Conceptualization: Z. Xiaoning; data acquisition: A. Wufuer, P. Mijiti; formal analysis: A. Wufuer, ZJ; methodology: P. Mijiti, C. Jian; resources: A. Wufuer, C. Jian, TS; software: P. Mijiti, M. Jianhua; validation: TS, M. Jianhua; writing of original draft: A. Wufuer, PW, Z. Xiaoning; review and editing: A. Wufuer, Z. Xiaoning; A. Wufuer and P. Mijiti share first authorship.

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Wufuer, A., Mijiti, P., Abudusalamu, R. et al. Blood pressure and collateral circulation in acute ischemic stroke. Herz 44, 455–459 (2019). https://doi.org/10.1007/s00059-018-4691-5

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  • DOI: https://doi.org/10.1007/s00059-018-4691-5

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