Translesional Pressure Gradient Alters Relationship Between Blood Pressure and Recurrent Stroke in Intracranial Stenosis
- 1 June 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 51 (6), 1862-1864
- https://doi.org/10.1161/strokeaha.119.028616
Abstract
Background and Purpose— There is debate over an optimal systolic blood pressure (SBP) in secondary stroke prevention of patients with symptomatic intracranial atherosclerotic stenosis (sICAS). We investigated whether translesional pressure gradient across sICAS would alter the relationship between SBP and risk of recurrent stroke in such patients. Methods— We recruited patients with sICAS (50%–99% stenosis) confirmed in computed tomography angiography. We simulated blood flow across sICAS with computed tomography angiography-based computational fluid dynamics models. Translesional pressure ratio (PR=Pressurepost-stenotic /Pressurepre-stenotic) post-stenotic pre-stenotic was calculated in each case. Pressure ratio (PR) ≤ median was defined as low PR, indicating larger translesional pressure gradient across sICAS. All patients received optimal medical treatment. We investigated the interaction of translesional PR and mean SBP during follow-up (SBPFU) in determining the risk of the primary outcome, recurrent ischemic stroke in the same territory within 1 year. Results— Among 157 patients with sICAS, the median PR was 0.93. Multivariate Cox regression revealed significant PR-SBPFU interaction on the primary outcome (P=0.008): in patients with normal PR, risk of primary outcome significantly decreased with lower SBPFU (hazard ratio for 10 mm Hg decrement =0.46; P=0.018); however, in those with low PR, SBPFU≤130 mm Hg was associated with significantly increased risk of primary outcome, compared with 130FUP=0.043). Conclusions— Low SBP level may be associated with increased risk of stroke recurrence in patients with sICAS with a large translesional pressure gradient. Translesional PR by computational fluid dynamics models may yield a promising indicator to guide more individualized blood pressure management in patients with sICAS, warranting future studies.Keywords
This publication has 10 references indexed in Scilit:
- Stroke Mechanisms in Symptomatic Intracranial Atherosclerotic DiseaseStroke, 2019
- Hemodynamics and stroke risk in intracranial atherosclerotic diseaseAnnals of Neurology, 2019
- Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flowJournal of Cerebral Blood Flow & Metabolism, 2018
- Impaired cerebral autoregulation: measurement and application to strokeJournal of Neurology, Neurosurgery & Psychiatry, 2017
- Misery Perfusion, Blood Pressure Control, and 5-Year Stroke Risk in Symptomatic Major Cerebral Artery DiseaseStroke, 2015
- Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic AttackStroke, 2014
- Impaired perfusion modifies the relationship between blood pressure and stroke risk in major cerebral artery diseaseJournal of Neurology, Neurosurgery & Psychiatry, 2013
- Stenting versus Aggressive Medical Therapy for Intracranial Arterial StenosisThe New England Journal of Medicine, 2011
- Risk factor status and vascular events in patients with symptomatic intracranial stenosisNeurology, 2007
- Relationship Between Blood Pressure and Stroke Recurrence in Patients With Intracranial Arterial StenosisCirculation, 2007