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    Blood Pressure May Be Associated with Arterial Collateralization in Anterior Circulation Ischemic Stroke before Acute Reperfusion Therapy

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    14
    Author
    Jiang, B; Churilov, L; Kanesan, L; Dowling, R; Mitchell, P; Dong, Q; Davis, S; Yan, B
    Date
    2017-05-01
    Source Title
    Journal of stroke
    Publisher
    KOREAN STROKE SOC
    University of Melbourne Author/s
    Churilov, Leonid; Dowling, Richard; Davis, Stephen; Yan, Bernard; Mitchell, Peter; JIANG, BEISI
    Affiliation
    Medicine and Radiology
    Metadata
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    Document Type
    Journal Article
    Citations
    Jiang, B., Churilov, L., Kanesan, L., Dowling, R., Mitchell, P., Dong, Q., Davis, S. & Yan, B. (2017). Blood Pressure May Be Associated with Arterial Collateralization in Anterior Circulation Ischemic Stroke before Acute Reperfusion Therapy. JOURNAL OF STROKE, 19 (2), pp.222-228. https://doi.org/10.5853/jos.2016.01739.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/259092
    DOI
    10.5853/jos.2016.01739
    Abstract
    BACKGROUND AND PURPOSE: Leptomeningeal collaterals maintain arterial perfusion in acute arterial occlusion but may fluctuate subject to arterial blood pressure (ABP). We aim to investigate the relationship between ABP and collaterals as assessed by computer tomography (CT) perfusion in acute ischemic stroke. METHODS: We retrospectively analyzed acute anterior circulation ischemic stroke patients with CT perfusion from 2009 to 2014. Collateral status using relative filling time delay (rFTD) determined by time delay of collateral-derived contrast opacification within the Sylvian fissure, from 0 seconds to unlimited count. The data were analyzed by zero-inflated negative binomial regression model including an appropriate interaction examining in the model in terms of occlusion location and onset-to-CT time (OCT). RESULTS: Two hundred and seventy patients were included. We found that increment of 10 mm Hg in BP, the odds that a patient would have rFTD equal to 0 seconds increased by 27.9% in systolic BP (SBP) (p=0.001), by 73.9% in diastolic BP (DBP) (p<0.001) and by 68.5% in mean BP (MBP) (p<0.001). For patients with rFTD not necessarily equal to 0 seconds, every 10 mm Hg increase in BP, there was a 7% decrease in expected count of seconds for rFTD in SBP (p=0.002), 10% decrease for rFTD in DBP and 11% decrease for rFTD in MBP. The arterial occlusion location and OCT showed no significant interaction in the BP-rFTD relationship (p>0.05). CONCLUSIONS: In acute ischemic stroke, higher ABP is possibly associated with improved leptomeningeal collaterals as identified by decreased rFTD.

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