Dynamic cerebral autoregulation post endovascular thrombectomy in acute ischemic stroke

Faheem Sheriff*, Pedro Castro, Mariel Kozberg, Sarah Larose, Andrew Monk, Elsa Azevedo, Karen Li, Sameen Jafari, Shyam Rao, Fadar Oliver Otite, Ayaz Khawaja, Farzaneh Sorond, Steven Feske, Can Ozan Tan, Henrikas Vaitkevicius

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

The development of the endovascular thrombectomy (EVT) technique has revolutionized acute stroke management for patients with large vessel occlusions (LVOs). The impact of successful recanalization using an EVT on autoregulatory profiles is unknown. A more complete understanding of cerebral autoregulation in the context of EVT may assist with post-procedure hemodynamic optimization to prevent complications. We examined cerebral autoregulation in 107 patients with an LVO in the anterior circulation (proximal middle cerebral artery (M1/2) and internal cerebral artery (ICA) terminus) who had been treated using an EVT. Dynamic cerebral autoregulation was assessed at multiple time points, ranging from less than 24 hours to 5 days following last seen well (LSW) time, using transcranial Doppler ultrasound recordings and transfer function analysis. Complete (Thrombolysis in Cerebral Infarction (TICI) 3) recanalization was associated with a more favorable autoregulation profile compared with TICI 2b or poorer recanalization (p < 0.05), which is an effect that was present after accounting for differences in the infarct volumes. Less effective autoregulation in the first 24 h following the LSW time was associated with increased rates of parenchymal hematoma types 1 and 2 hemorrhagic transformations (PH1– PH2). These data suggest that patients with incomplete recanalization and poor autoregulation (especially within the first 24 h post-LSW time) may warrant closer blood pressure monitoring and control in the first few days post ictus.

Original languageEnglish (US)
Article number641
Pages (from-to)1-12
Number of pages12
JournalBrain Sciences
Volume10
Issue number9
DOIs
StatePublished - Sep 2020

Keywords

  • Dynamic cerebral autoregulation
  • Endovascular thrombectomy
  • Stroke
  • Transcranial doppler ultrasound

ASJC Scopus subject areas

  • Neuroscience(all)

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