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Early microvascular cerebral blood flow response to head-of-bed elevation is related to outcome in acute ischemic stroke

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Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

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Funding

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).

Author information

Authors and Affiliations

  1. ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Av. Carl Friedrich Gauss, 3, Castelldefels, Barcelona, 08860, Spain

    Clara Gregori-Pla, Igor Blanco, Peyman Zirak, Gianluca Cotta, Federica Maruccia, Giacomo Giacalone & Turgut Durduran

  2. Department of Neurology, Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Pol Camps-Renom, Luís Prats-Sánchez, Alejandro Martínez-Domeño, Joan Martí-Fàbregas & Raquel Delgado-Mederos

  3. Centre de Recerca Matemàtica (CRM), Bellaterra, Spain

    Isabel Serra

  4. Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron University Research Institute, Barcelona, Spain

    Federica Maruccia

  5. Departments of Anesthesiology and Pain Management; Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    David R. Busch

  6. San Raffaele Scientific Institute, Milan, Italy

    Giacomo Giacalone

  7. Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain

    Turgut Durduran

Authors
  1. Clara Gregori-Pla
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  2. Igor Blanco
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  3. Pol Camps-Renom
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  4. Peyman Zirak
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  5. Isabel Serra
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  6. Gianluca Cotta
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  7. Federica Maruccia
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  8. Luís Prats-Sánchez
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  9. Alejandro Martínez-Domeño
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  10. David R. Busch
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  11. Giacomo Giacalone
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  12. Joan Martí-Fàbregas
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  13. Turgut Durduran
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  14. Raquel Delgado-Mederos
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Corresponding author

Correspondence to Clara Gregori-Pla.

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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.

Ethical standard

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.

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Gregori-Pla, C., Blanco, I., Camps-Renom, P. et al. Early microvascular cerebral blood flow response to head-of-bed elevation is related to outcome in acute ischemic stroke. J Neurol 266, 990–997 (2019). https://doi.org/10.1007/s00415-019-09226-y

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  • DOI: https://doi.org/10.1007/s00415-019-09226-y

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