Misery Perfusion, Blood Pressure Control, and 5-Year Stroke Risk in Symptomatic Major Cerebral Artery Disease
- 1 January 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 46 (1), 265-268
- https://doi.org/10.1161/strokeaha.114.007134
Abstract
Background and Purpose—: The benefit of strict blood pressure (BP) control in high-risk patients with symptomatic major cerebral artery disease and misery perfusion (MP) is controversial. Our purposes were (1) to determine whether MP is a predictor of a 5-year risk of subsequent stroke and (2) to investigate the relationships among BP during follow-up, MP, and the stroke risk. Methods—: We studied 130 nondisabled patients with symptomatic major cerebral artery disease. Baseline hemodynamic measurements were obtained from 15 O-gas positron emission tomography, and patients received medical treatment and they were followed for 5 years or until stroke recurrence or death. Results—: During 5 years, strokes occurred in 6 of 16 patients with MP and in 15 of 114 without MP (log-rank test; P P <0.001). The risk of ipsilateral ischemic stroke declined markedly after 2 years, and there was only 1 ipsilateral ischemic stroke in a patient without MP. Normal systolic BP (<130 mm Hg) was associated with an increased risk of ipsilateral ischemic strokes in patients with impaired perfusion (including MP), whereas systolic BP outside the 130 to 149 mm Hg range was associated with an increased risk of all strokes in patients without MP. Conclusion—: Patients with MP showed a high-5-year stroke recurrence, but a large part of the 5-year stroke risk disappeared after 2 years. Aggressive BP control may be hazardous in patients with impaired perfusion, including MP.This publication has 10 references indexed in Scilit:
- Lower stroke risk with lower blood pressure in hemodynamic cerebral ischemiaNeurology, 2014
- Impaired perfusion modifies the relationship between blood pressure and stroke risk in major cerebral artery diseaseJournal of Neurology, Neurosurgery & Psychiatry, 2013
- Intervention versus standard medical treatment in patients with symptomatic occlusion of the internal carotid artery: a randomised oxygen-15 PET studyEJNMMI Research, 2013
- Is misery perfusion still a predictor of stroke in symptomatic major cerebral artery disease?Brain, 2012
- Extracranial-Intracranial Bypass Surgery for Stroke Prevention in Hemodynamic Cerebral IschemiaJAMA, 2011
- Haemodynamic stroke: clinical features, prognosis, and managementThe Lancet Neurology, 2010
- Symptomatic internal carotid artery occlusion: a long-term follow-up studyJournal of Neurology, Neurosurgery & Psychiatry, 2010
- Patterns of Infarction in Hemodynamic FailureCerebrovascular Diseases, 2007
- Evaluation of the ratio of cerebral blood flow to cerebral blood volume as an index of local cerebral perfusion pressure [published erratum appears in Brain 1998 Oct;121(pt 10):2027]Brain, 1998
- Reversal of focal "misery-perfusion syndrome" by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography.Stroke, 1981