Abstract Details

Title Linking Systemic Hemodynamics, Blood Pressure Variability, and Autoregulatory Impairment in Acute Ischemic Stroke

Topic Neuro Trauma and Critical Care

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 19-006

Objective To determine whether cardiovascular hemodynamic measures can serve as physiologic biomarkers for early identification of acute ischemic stroke patients at risk for high blood pressure variability (BPV) and impaired cerebral autoregulation.

Background Both elevated BPV and impaired cerebral autoregulation are independently associated with worse functional outcomes after acute ischemic stroke. Perturbations in systemic hemodynamics, such as reduced cardiac output or intravascular volume depletion, can destabilize cerebral perfusion, leading to increased BPV and compromised autoregulatory capacity. Characterizing these relationships may enable physiologically informed risk stratification and individualized blood pressure management in the acute stroke setting.

Design/Methods From a prospectively maintained stroke database, we identified 42 patients who underwent 24-hour continuous physiologic monitoring after thrombectomy. Cerebral autoregulation was assessed using a NIRS-derived cerebral oxygenation index to calculate the optimal mean arterial pressure (MAPopt). The average absolute deviation of MAP from MAPopt and BPV (standard deviation of MAP) were computed over 24 hours. Linear regression analyses examined relationships between cardiac index (CI), BPV, and MAPopt deviation, with additional analyses focused on the first 6 hours post-reperfusion.

Results Over 24 hours following reperfusion, lower CI was associated with greater deviation of MAP from MAPopt (B = -1.79, p = 0.03) and showed a non-significant inverse relationship with BPV (B = -1.19, p = 0.10). Lower CI predicted higher BPV (B = -2.25, p = 0.03) and greater deviation from MAPopt during the first 6 hours after reperfusion (B = -3.33, p = 0.03).

Conclusions In this preliminary analysis of acute ischemic stroke patients, lower CI was associated with higher BPV and greater deviation from autoregulation-based optimal blood pressure targets, both linked to worse functional outcomes. CI may therefore represent a physiologic biomarker for early identification of high-risk stroke patients and a potential target for hemodynamic optimization.

Authors/Disclosures
Pwint Thinzar PRESENTER	Ms. Thinzar has nothing to disclose.
David J. Vargas Estrella	Mr. Vargas Estrella 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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