Abstract Details

Title Poor Collaterals and Rapid Early Infarct Progression Are Associated With Increased Vulnerability to Blood Pressure Reductions

Topic Neurocritical Care

Presentation(s) S21 - Neurocritical Care (1:12 PM-1:24 PM)

Poster/Presentation
Number 002

Background

Precise interactions between collateral perfusion, hemodynamics, and infarct growth rate after large vessel occlusion (LVO) remain unknown. This study examined whether patients with poor collateral circulation and rapid early infarct progression are more vulnerable to blood pressure (BP) reductions.

Objective

To study how blood pressure reductions prior to reperfusion during endovascular thrombectomy affect infarct progression.

Design/Methods

LVO stroke patients who underwent endovascular thrombectomy (EVT) were prospectively enrolled. Volumes of arterial tissue delay and relative cerebral blood flow (CBF) were estimated with RAPID software; a poor collateral profile was defined by a hypoperfusion intensity ratio > 0.4. Early infarct growth rate (EIGR) was defined as ischemic core volume (CBF<30%) divided by the time from symptom onset to imaging. A fast progressor profile was assigned to patients whose EIGR was > 10 mL/h. The final infarct growth rate (FIGR) was the quotient of final infarct volume (FIV) and time from symptom onset to reperfusion. BP reduction was measured as the difference between admission mean arterial pressure (MAP) and lowest MAP before reperfusion.

Results Fifty-five patients (mean age 69±15, mean NIHSS 13) with successful reperfusion (TICI 2B/3) were analysed. The median MAP reduction was 17 (IQR 9, 32). Poor collateral perfusion and EIGR were independent predictors of FIV after adjusting for age and admission NIHSS (mean FIV 70 vs. 31 mL, p=0.012 and 60 vs. 29 mL, p=0.01, respectively). A significant interaction was found between MAP reduction and both collateral status (p=0.04) and progressor profile (p=0.01). For every 10 mmHg MAP reduction, patients with poor collaterals experienced an average increase in FIGR of 3.6 mL/h. Above a critical MAP reduction threshold of 30 mmHg, mean FIV was significantly larger in patients with rapidly progressing infarcts (p<0.01).

Conclusions Fast progressor patients with poor collaterals are at higher risk of accelerated FIGR and larger FIV related to BP reductions.

Authors/Disclosures
Yelyzaveta Begunova PRESENTER	Miss Begunova has nothing to disclose.
David Bartolome (Yale University School of Medicine)	Mr. Bartolome has nothing to disclose.
Jessica Kobsa (Yale University)	Ms. Kobsa has nothing to disclose.
Alexandria Soto	Ms. Soto has nothing to disclose.
Ayush Prasad (Yale School of Medicine & Yale - New Haven Hospital)	Mr. Prasad has nothing to disclose.
Milagros Galecio-Castillo, MD (University of Iowa Hospitals and Clinics)	Dr. Galecio-Castillo has nothing to disclose.
Juan A. Vivanco-Suarez, MD	Mr. Vivanco-Suarez has nothing to disclose.
Darko E. Quispe Orozco, MD (TTUHSC-SOM, Lubbock; Neurology Dept.)	Dr. Quispe Orozco has nothing to disclose.
Mudassir Farooqui, MD	Dr. Farooqui has nothing to disclose.
Lauren H. Sansing, MD	Dr. Sansing has nothing to disclose.
Joseph Schindler, MD (Yale University Department of Neurology)	Dr. Schindler has received personal compensation for serving as an employee of Aeromics. Dr. Schindler has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for Aeromics. Dr. Schindler has received stock or an ownership interest from Aeromics. Dr. Schindler has received publishing royalties from a publication relating to health care.
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has stock in Certus. Dr. De Havenon has stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Charles Matouk	No disclosure on file
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for microvention. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH.
Nils Petersen, MD (Yale University)	Dr. Petersen has received research support from NIH.