Early blood pressure changes during systemic thrombolysis and its association with unexplained early neurological deterioration in small subcortical infarct

Early neurological deterioration (END), observed in the acute phase of small subcortical infarct treated with intravenous thrombolysis (IVT), is not uncommon in these patients. However, in over half of the END cases, the exact cause is yet incompletely understood, which is so‐called unexplained END...

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Published in:The journal of clinical hypertension (Greenwich, Conn.) Conn.), 2022-08, Vol.24 (8), p.1086-1094
Main Authors: Wei, Xiu'e, Duan, Zuowei, Zhai, Yujia, Zhang, Cuicui, Zhang, Jun, Hu, Ting, Liu, Tengfei, Liu, Zhenqian, Xu, Jiang, Liu, Haiyan, Rong, Liangqun
Format: Article
Language:English
Subjects:
Blood pressure
blood pressure variability
Cardiac arrhythmia
Diabetes
early neurological deterioration
Edema
excursions
Hemorrhage
Hypertension
Ischemia
Magnetic resonance imaging
Original
outcome
Patients
small subcortical infarct
Stroke
Variables
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Summary:Early neurological deterioration (END), observed in the acute phase of small subcortical infarct treated with intravenous thrombolysis (IVT), is not uncommon in these patients. However, in over half of the END cases, the exact cause is yet incompletely understood, which is so‐called unexplained END (unEND). Our aim was to investigate the association of early blood pressure (BP) changes with unEND in patients with small subcortical infarct in the perforator territory of middle cerebral artery treated with IVT. Consecutive patients with acute small subcortical infarct treated with IVT were enrolled in this study. unEND was defined as≧2‐point increase of NIHSS from baseline to 24 hours, without straightforward causes. BP excursions and BP variability were calculated and compared between patients with unNED and those without. A total of 168 patients with acute small subcortical infarct were included. Of them, there were 29 patients with unEND and 139 without END. During the first 24 hours following IVT, 66 (39.29%) patients had at least one BP excursion. Logistic regression analyses indicated that BP excursion presence (OR = 3.185, 95% CI: 1.238‐8.198), SBP excursion presence (OR = 3.535, 95% CI: 1.366‐9.143), and number of SBP excursion (OR = 1.466, 95% CI: 1.090‐1.973) were independently associated with unEND. Although SBPSD (P 
ISSN:1524-6175
1751-7176
DOI:10.1111/jch.14515