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Dynamic cerebral autoregulation is transiently impaired for one week after large-vessel acute ischemic stroke

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dc.contributor.author Petersen, Nils
dc.contributor.author Ortega-Gutiérrez, Santiago
dc.contributor.author Reccius, Andrés
dc.contributor.author Masurkar, Arjun
dc.contributor.author Huang, Amy
dc.contributor.author Marshall, Randolph
dc.date.accessioned 2016-05-23T20:25:06Z
dc.date.available 2016-05-23T20:25:06Z
dc.date.issued 2015
dc.identifier.citation Cerebrovascular Diseases, 2015, vol.39 n°2, p.144-50
dc.identifier.uri http://hdl.handle.net/11447/323
dc.identifier.uri http://dx.doi.org/10.1159/000368595
dc.description.abstract BACKGROUND: Dynamic cerebral autoregulation (DCA) is the continuous counterregulation of cerebral blood flow to fluctuations in blood pressure. DCA can become impaired after acute stroke, but it remains unclear to what extent and over what interval this occurs. METHODS: We included 28 patients (NIHSS = 12 ± 6.5, age = 68.4 ± 17.1, 16F) with acute large-vessel ischemic stroke in the middle cerebral artery territory and 29 healthy controls (mean age 54.9 ± 9, 16F). DCA was assessed by simultaneous measurement of blood pressure together with blood flow velocities using finger plethysmography/arterial catheter and transcranial Doppler over three 10-minute recordings on days 0-2, 3-6 and ≥7 days after stroke. Transfer function analysis was applied to calculate average phase shift (PS) in the low frequency range (0.06-0.12 Hz). Less PS indicated poorer autoregulation. The affected side was compared with the unaffected side and controls. Univariate comparisons of data were performed using t tests at single time points, and generalized estimating equations with an exchangeable correlation matrix to examine the change in PS over time. RESULTS: At mean 1.3 ± 0.5 days after stroke the average PS in the affected hemisphere was 29.6 ± 10.5 vs. 42.5 ± 13 degrees in the unaffected hemisphere (p = 0.004). At 4.1 ± 1 days, the PS in affected and unaffected hemisphere was 23.2 ± 19.1 vs. 41.7 ± 18.5 degrees, respectively (p = 0.003). At mean 9.75 ± 2.2 days stroke there was no difference between the affected and the unaffected hemisphere (53.2 ± 28.2 vs. 50.7 ± 29.2 degrees, p = 0.69). Control subjects had an average PS = 47.9 ± 16.8, significantly different from patients' affected hemisphere at the first two measurements (p = 0.001), but not the third (p = 0.37). The PS in controls remained unchanged on repeat testing after an average 19.1 days (48.4 ± 17.1, p = 0.61). Using the last recording as the reference, the average PS in the affected hemisphere was -23.54 (-44.1, -3) degrees lower on recording one (p = 0.025), and -31.6 (-56.1, -7.1) degrees lower on recording two (p < 0.011). Changes in the unaffected hemisphere over time were nonsignificant. DISCUSSION: These data suggest that dynamic cerebral autoregulation is impaired in the affected hemisphere throughout the first week after large-vessel ischemic stroke, and then normalizes by week two. These findings may have important implications for acute blood pressure management after stroke.
dc.language.iso en_US
dc.publisher S. Karger AG, Basel.
dc.subject Dynamic cerebral autoregulation
dc.subject Stroke
dc.subject Transcranial doppler
dc.subject Transfer function analysis
dc.title Dynamic cerebral autoregulation is transiently impaired for one week after large-vessel acute ischemic stroke
dc.type Artículo


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