Prognostic significance of blood pressure variability after thrombolysis in acute stroke
Archit C. Bhatt MD,MPH, Michigan State University, Department of Neurology and Ophthalmology, 138 Service Rd., East Lansing, MI 38824archit.bhatt@ht.msu.edu
Muhammad U. Farooq, MD
Submitted November 21, 2008
Delgado-Mederos et al. consider the issue of blood pressure regulation in acute hemispheric ischemic stroke and effectively demonstrate the difference in blood pressure variability in non-recanalized patients with low and high physical morbidity. [1]
The authors also show that blood pressure variability is independently associated with DWI lesion growth and clinical course. However, in non-recanalized patients, the baseline perfusion was different in both groups but not statistically significant (Table 2). It has been shown that low hemispheric perfusion demonstrated by perfusion weighted imaging correlates with the penumbra and the future infarct size. [2]
While this PWI-DWI mismatch might be statistically insignificant, it is clinically relevant in this case. These patients might be inherently vulnerable and blood pressure variability might increase the infarct size.
References
1. Delgado-Mederos R, Ribo M, Rovira A, et al. Prognostic significance of blood pressure variability after thrombolysis in acute stroke. Neurology 2008;71:552-558.
2. Lubya, Waracha S. Reliability of MR Perfusion-Weighted and Diffusion-Weighted Imaging Mismatch Measurement Methods. American Journal of Neuroradiology 2007;28:1674-1678.
Editor’s Note: The authors of the article were offered the opportunity to respond but declined.
Delgado-Mederos et al. consider the issue of blood pressure regulation in acute hemispheric ischemic stroke and effectively demonstrate the difference in blood pressure variability in non-recanalized patients with low and high physical morbidity. [1]
The authors also show that blood pressure variability is independently associated with DWI lesion growth and clinical course. However, in non-recanalized patients, the baseline perfusion was different in both groups but not statistically significant (Table 2). It has been shown that low hemispheric perfusion demonstrated by perfusion weighted imaging correlates with the penumbra and the future infarct size. [2]
While this PWI-DWI mismatch might be statistically insignificant, it is clinically relevant in this case. These patients might be inherently vulnerable and blood pressure variability might increase the infarct size.
References
1. Delgado-Mederos R, Ribo M, Rovira A, et al. Prognostic significance of blood pressure variability after thrombolysis in acute stroke. Neurology 2008;71:552-558.
2. Lubya, Waracha S. Reliability of MR Perfusion-Weighted and Diffusion-Weighted Imaging Mismatch Measurement Methods. American Journal of Neuroradiology 2007;28:1674-1678.
Editor’s Note: The authors of the article were offered the opportunity to respond but declined.
Disclosure: The authors report no disclosures.