한빛사 논문
Tae Jung Kim, MD1; Hee-Kwon Park, MD, PhD2; Jeong-Min Kim, MD, PhD3; Ji Sung Lee, PhD4; Soo-Hyun Park, MD, PhD1; Hae-Bong Jeong, MD1; Kwang-Yeol Park, MD, PhD3; Joung-Ho Rha, MD, PhD;2 Byung-Woo Yoon, MD, PhD1; and Sang-Bae Ko, MD, PhD1, *
1 Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
2 Department of Neurology, Inha University School of Medicine, Incheon, Korea
3Department of Neurology, Chung Ang University Hospital, Seoul, Korea
4Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea
*Address for correspondence: Sang-Bae Ko, MD, PhD
Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
Abstract
Objective
Although BP variability has been regarded as a risk factor for hemorrhagic transformation (HTF) after intravenous thrombolysis, its effect on HTF after endovascular recanalization therapy (ERT) remains to be elucidated. We aimed to study the relationship between BP variability and symptomatic intracerebral hemorrhage (sICH) after successful recanalization with ERT.
Methods
A total of 211 patients with acute ischemic stroke and successful recanalization (Thrombolysis in Cerebral Infarction 2b or 3) after ERT were included between January 2013 and May 2017. The BP data following ERT was obtained over the first 24 hours using parameters including mean, maximum, minimum, difference between maximum and minimum, standard deviation, coefficient of variation, successive variations, and time rate (TR) of BP variation for systolic BP (SBP) and diastolic BP (DBP). sICH was defined as parenchymal hemorrhage type 2 with neurological deterioration of 4 points of more on the National Institute of Health Stroke Scale.
Results
Among the included patients, 20 (9.5%) developed sICH after successful ERT. The parameters linked with BP fluctuation over time were significantly related to sICH. After adjusting for confounders, the TR of SBP (per 0.1 mmHg/min increase) variation was independently associated with sICH (odds ratio, 1.71; 95% confidence interval, 1.013-2.886).
Interpretation
Time-related BP variability in the first 24 hours following successful ERT was more correlated with sICH than other absolute BP level. This suggests that maintaining a stable BP may be an important factor in preventing sICH after successful ERT.
Keywords: Blood pressure variability, hemorrhagic transformation, successful recanalization, endovascular recanalization therapy
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