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Autoregulation after ischaemic stroke.

Publication ,  Journal Article
Powers, WJ; Videen, TO; Diringer, MN; Aiyagari, V; Zazulia, AR
Published in: J Hypertens
November 2009

OBJECTIVES: Absent outcome data from randomized clinical trials, management of hypertension in acute ischaemic stroke remains controversial. Data from human participants have failed to resolve the question whether cerebral blood flow (CBF) in the peri-infarct region will decrease due to impaired autoregulation when systemic mean arterial pressure (MAP) is rapidly reduced. METHODS: Nine participants, 1-11 days after hemispheric ischaemic stroke, with systolic blood pressure more than 145 mmHg, underwent baseline PET measurements of regional CBF. Intravenous nicardipine infusion was then used to rapidly reduce mean arterial pressure 16 +/- 7 mmHg and CBF measurement was repeated. RESULTS: Compared with the contralateral hemisphere, there were no significant differences in the percent change in CBF in the infarct (P = 0.43), peri-infarct region (P = 1.00) or remainder of the ipsilateral hemisphere (P = 0.50). Two participants showed CBF reductions of greater than 19% in both hemispheres. CONCLUSION: In this study, selective regional impairment of CBF autoregulation in the infarcted hemisphere to reduced systemic blood pressure was not a characteristic of acute cerebral infarction. Reductions in CBF did occur in some individuals, but it was bihemispheric phenomenon that likely was due to an upward shift of the autoregulatory curve as a consequence of chronic hypertension. These results indicate individual monitoring of changes in global CBF, such as with bedside transcranial Doppler, may be useful to determine individual safe limits when MAP is lowered in the setting of acute ischaemic stroke. The benefit of such an approach can only be demonstrated by clinical trials demonstrating improved patient outcome.

Duke Scholars

Published In

J Hypertens

DOI

EISSN

1473-5598

Publication Date

November 2009

Volume

27

Issue

11

Start / End Page

2218 / 2222

Location

Netherlands

Related Subject Headings

  • Stroke
  • Positron-Emission Tomography
  • Nicardipine
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular System & Hematology
  • Brain Ischemia
  • Aged
 

Citation

APA
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Powers, W. J., Videen, T. O., Diringer, M. N., Aiyagari, V., & Zazulia, A. R. (2009). Autoregulation after ischaemic stroke. J Hypertens, 27(11), 2218–2222. https://doi.org/10.1097/HJH.0b013e328330a9a7
Powers, William J., Tom O. Videen, Michael N. Diringer, Venkatesh Aiyagari, and Allyson R. Zazulia. “Autoregulation after ischaemic stroke.J Hypertens 27, no. 11 (November 2009): 2218–22. https://doi.org/10.1097/HJH.0b013e328330a9a7.
Powers WJ, Videen TO, Diringer MN, Aiyagari V, Zazulia AR. Autoregulation after ischaemic stroke. J Hypertens. 2009 Nov;27(11):2218–22.
Powers, William J., et al. “Autoregulation after ischaemic stroke.J Hypertens, vol. 27, no. 11, Nov. 2009, pp. 2218–22. Pubmed, doi:10.1097/HJH.0b013e328330a9a7.
Powers WJ, Videen TO, Diringer MN, Aiyagari V, Zazulia AR. Autoregulation after ischaemic stroke. J Hypertens. 2009 Nov;27(11):2218–2222.

Published In

J Hypertens

DOI

EISSN

1473-5598

Publication Date

November 2009

Volume

27

Issue

11

Start / End Page

2218 / 2222

Location

Netherlands

Related Subject Headings

  • Stroke
  • Positron-Emission Tomography
  • Nicardipine
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular System & Hematology
  • Brain Ischemia
  • Aged