Efficacy of cerebral autoregulation in early ischemic stroke predicts smaller infarcts and better outcome

Pedro Castro*, Jorge Manuel Serrador, Isabel Rocha, Farzaneh Sorond, Elsa Azevedo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

Background and purpose: Effective cerebral autoregulation (CA) may protect the vulnerable ischemic penumbra from blood pressure fluctuations and minimize neurological injury. We aimed to measure dynamic CA within 6 h of ischemic stroke (IS) symptoms onset and to evaluate the relationship between CA, stroke volume, and neurological outcome. Methods: We enrolled 30 patients with acute middle cerebral artery IS. Within 6 h of IS, we measured for 10 min arterial blood pressure (Finometer), cerebral blood flow velocity (transcranial Doppler), and end-tidal-CO2. Transfer function analysis (coherence, phase, and gain) assessed dynamic CA, and receiver-operating curves calculated relevant cut-off values. National Institute of Health Stroke Scale was measured at baseline. Computed tomography at 24 h evaluated infarct volume. Modified Rankin Scale (MRS) at 3 months evaluated the outcome. Results: The odds of being independent at 3 months (MRS 0-2) was 14-fold higher when 6 h CA was intact (Phase > 37°) (adjusted OR = 14.0 (IC 95% 1.7-74.0), p = 0.013). Similarly, infarct volume was significantly smaller with intact CA [median (range) 1.1 (0.2-7.0) vs 13.1 (1.3-110.5) ml, p = 0.002]. Conclusion: In this pilot study, early effective CA was associated with better neurological outcome in patients with IS. Dynamic CA may carry significant prognostic implications.

Original languageEnglish (US)
Article number113
JournalFrontiers in Neurology
Volume8
Issue numberMAR
DOIs
StatePublished - Mar 24 2017

Keywords

  • Blood pressure
  • Cerebral autoregulation
  • Ischemic stroke
  • Stroke
  • Transcranial Doppler

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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