Effect of early elevated blood pressure on early neurological deterioration (END) after intravenous thrombolytic therapy for isolated small subcortical infarct (ISSI) in elderly patients
10.3760/cma.j.issn.1671-0282.2024.12.009
- VernacularTitle:早期血压升高对老年孤立性皮质下小梗死静脉溶栓后早期神经功能恶化的影响
- Author:
Fei LU
1
;
Jianqi ZHAO
Author Information
1. 徐州医科大学第二附属医院急诊科，徐州 221006
- Keywords:
stroke;
subcortical;
Early neurological deterioration;
Blood pressure;
Intravenous thrombolysis;
Excursions;
Outcome;
Lesion Pattern
- From:
Chinese Journal of Emergency Medicine
2024;33(12):1720-1725
- CountryChina
- Language:Chinese
-
Abstract:
Obiective:To investigate the association of blood pressure (BP) excursions with early neurological deterioration (END) in patients with isolated small subcortical infarct (ISSI) treated with intravenous thrombolysis (IVT).Methods:Consecutive patients with acute ISSI treated with IVT were prospectively registered from the Emergency Department, the Second Affiliated Hospital of Xuzhou Medical University between Jun 2018 and Dec 2022. END was defined as an NIHSS score increased≥2 during the first 24 hours compared with the initial NIHSS score. BP excursions, defined as greater than 185 systolic BP (SBP) or greater than 110 diastolic BP (DBP) were calculated and compared between patients with NED and those without (ED).Results:A total of 205 patients with acute ISSI in the perforator territory of the MCA were included in this study. Of them, 47(22.93%) patients developed END and 88(42.93%) patients had at least one BP excursion during the first 24 h following tPA bolus. Univariate analysis indicated that age, sex, baseline NIHSS, diabetes mellitus, previous mRS score≥2, BP excursion presence and SBP excursion presence significantly associated with the development of END ( P<0.05). Logistic regression analyses indicated that BP excursion presence ( OR=3.460, 95% CI: 1.604-7.465, P=0.002) and SBP excursion presence ( OR=3.619, 95% CI: 1.684-7.776, P=0.001) were independently associated with END. Conclusions:BP excursions above guideline thresholds during the first 24 h following IVT administration for ISSI is common and independently associated with END.
