Association between neurologic improvement with decline in blood pressure and recanalization in stroke.
Association between neurologic improvement with decline in blood pressure and recanalization in stroke.
复制标题
神经系统改善与血压降低与中风再通电之间的关联。
DOI：
10.1001/jamaneurol.2014.2036
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发表时间：
2014-12
期刊：
影响因子：
29
通讯作者：
Merino JG
中科院分区：
文献类型：
--
作者：
Nagaraja N;Warach S;Hsia AW;Adams HP Jr;Auh S;Latour LL;Merino JG
中风患者溶栓后血压常下降。尽管存在持续闭塞，但神经系统的改善可能来自于再通或更好的侧支血流。我们假设神经系统改善伴血压下降可能是静脉注射组织纤溶酶原激活剂后血管再通的临床症状。 1999年至2009年在马里兰州贝塞斯达郊区医院和华盛顿特区MedStar华盛顿医院中心接受静脉组织纤溶酶原激活剂治疗的患者如果接受过治疗前和24小时磁共振血管造影扫描、当时的美国国立卫生研究院卒中量表评分以及治疗前证实近端大脑中动脉闭塞，则被纳入研究。 24 小时磁共振血管造影的再通状态分为无、部分或完全。十七名患者符合研究标准。 24小时磁共振血管造影显示，3例患者无再通，8例部分再通，6例完全再通。溶栓后 24 小时，4 例部分再通患者、4 例完全再通患者出现神经系统改善，同时收缩压下降 20 mm Hg 或更高，而未再通患者则无一例。静脉注射组织纤溶酶原激活剂后神经系统改善，同时收缩压下降 20 mm Hg 或更高，可能是血管再通的临床症状。这一观察结果需要在更大的队列中得到证实。
Patients with stroke often have a decline in blood pressure after thrombolysis. Neurologic improvement could result from recanalization or better collateral flow despite persistent occlusion. We hypothesized that neurologic improvement with concurrent decline in blood pressure may be a clinical sign of recanalization after intravenous tissue plasminogen activator. Patients treated with intravenous tissue plasminogen activator at Suburban Hospital, Bethesda, Maryland, and MedStar Washington Hospital Center, Washington, DC, from 1999 to 2009 were included in the study if they had pretreatment and 24-hour magnetic resonance angiographic scans, National Institutes of Health Stroke Scale scores at those times, and proximal middle cerebral artery occlusion demonstrated prior to treatment. The recanalization status on 24-hour magnetic resonance angiography was classified as none, partial, or complete. Seventeen patients met study criteria. On 24-hour magnetic resonance angiography, 3 patients had no recanalization, 8 had partial recanalization, and 6 had complete recanalization. At 24 hours after thrombolysis, neurologic improvement with concurrent decline in systolic blood pressure of 20 mm Hg or greater was seen in 4 patients with partial recanalization, 4 patients with complete recanalization, and none of the patients with no recanalization. Neurologic improvement with concurrent decline in systolic blood pressure of 20 mm Hg or greater after intravenous tissue plasminogen activator may be a clinical sign of recanalization. This observation needs confirmation in a larger cohort.