Abstract Details

Title Enhancing Autoregulation-guided Blood Pressure Management after Large-vessel Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-010

Objective

To assess for hemispheric differences in autoregulation-based blood pressure (BP) targets and evaluate the benefits of incorporating data from the unaffected hemisphere.

Background

Continuous monitoring of regional cerebral oxygenation saturation (rSO2) in the affected hemisphere is commonly used to calculate autoregulation-based individualized BP targets for acute ischemic stroke patients. However, there is uncertainty regarding the applicability of these same BP targets to the unaffected cerebral hemisphere.

Design/Methods

All patients underwent continuous physiologic data recordings for 24 hours following thrombectomy. Cerebral autoregulation was calculated as a moving correlation coefficient between arterial BP and near-infrared spectroscopy-based rSO2. The resulting index was used to determine the mean arterial pressure at which autoregulation was most preserved (MAPopt). ANOVA was conducted to compare MAPopt values between the affected side, the unaffected side, and an average across both hemispheres. Reliability was assessed using Bland-Altman and intraclass correlation coefficient (ICC) analyses. Additionally, the time to achieve the first personalized BP target and the percentage of MAPopt availability were evaluated.

Results

In total, 189 patients (mean age 70.9, mean NIHSS 13.7, left/right LVO 50.8%/49.2%) were included in the study. The mean MAPopt for the affected side was 91.3mmHg, compared to 91.2mmHg for the unaffected side (p>0.05). Bland-Altman analysis indicated a minimal MAPopt bias, showing a discrepancy of 0.06mmHg for averaged vs. affected side and 0.19mmHg for averaged vs. unaffected side, along with an excellent ICC of 0.96 (95%CI 0.95-0.97, p<0.05). Using an average across both hemispheres increased the availability of MAPopt to 85.5%, versus 78.1% and 75.1% when considering affected and unaffected sides respectively. Moreover, the time to reach the first personalized BP target was shorter (94 minutes for averaged, compared to 124 and 125 minutes for affected and unaffected sides, respectively).

Conclusions

Personalized BP targets are consistent across hemispheres. Using data from both hemispheres decreases delays and improves MAPopt availability.

Authors/Disclosures
Pwint Thinzar PRESENTER	Ms. Thinzar has nothing to disclose.
Sithmi M. Jayasundara	Miss Jayasundara has nothing to disclose.
David J. Vargas Estrella	Mr. Vargas Estrella has nothing to disclose.
Kaitlyn Stoehr, MS5	Ms. Stoehr has nothing to disclose.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH. The institution of Dr. Ortega Gutierrez has received research support from PCORI.
Nils Petersen, MD (Yale University)	The institution of Dr. Petersen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Silkroad Medical. Dr. Petersen has received research support from NIH.

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