Effects Of Intensive Blood Pressure Lowering On The Early Reperfusion And Prognosis After Intravenous Thrombolysis In Patients With Acute Ischemic Stroke

Backgroud:Due to the aging population and bad life style,the incidence of cerebral ischemic stroke is increasing year by year.This disease is characterized by high mortality and morbidity.It also brings heavy economic pressure for the patients’families and society.The most effective treatment for acute ischemic stroke is intravenous thrombolysis with recombinant tissue plasminogen activator(rtPA)in therapeutic time window according to the current guidelines.The main factors affecting the prognosis after intravenous thrombolysis in patients with acute ischemic stroke are the reperfusion of ischemic regions and the occurrence of syptomatic intracerebral hemorrhage(sICH).The management of blood pressure is considered to be one of the major indexes influencing the two factors mentioned above.High blood pressure will aggravate cerebral edema by disruption of the blood-brain barrier while low blood pressure will lead to hypoperfusion and larger infarction area.At present,it is still a lack of sufficient evidence of evidence-based medicine about how to manage the blood pressure in acute period.And the relevant guidelines which recommend to control the level of blood pressure below 180/105mmHg after intravenous thrombolysis are just based on expert consensus.In the present study,we intend to investigate the effects of intensive blood pressure lowering on the early reperfusion and prognosis after intravenous thrombolysis in patients with acute ischemic stroke,contributing to provide more theoretical basis for the management of blood pressure in the acute period of ischemic stroke by multi-mode MRI.Objective:To compare the effects of intensive blood pressure(BP)lowering and guideline-recommended standard blood pressure lowering on the early reperfusion and prognosis after intravenous thrombolysis in patients with acute ischemic stroke.Methods:It’s a randomised controlled trail consisting of 118 consecutive patients accepting intravenous recombinant tissue plasminogen activator(rtPA)thrombolysis with the systolic blood pressure(SBP)among 150～185mmHg.The patients with ischemic stroke were diagnosed by Multi-mode MRI and confirmed to have ischemic penumbra.The SBP of patients randomly assigned to intensive BP lowering group and guideline BP lowering group was maintained in 140～150mmHg or below 180mmHg respectively for 72h and all patients needed to reexamination Multi-mode MRI at 24h.The primary endpoints were the neurologic function at early stage,modified Rankin Scale(mRS)score and the mortality at 90d;the secondary endpoints were the volume of infarction and hypoperfusion area,the rate of reperfusion,hemorrhagic transformation(HT)and syptomatic intracerebral hemorrhage(sICH).Results:49 cases in intensive BP lowering group and 56 cases in guideline BP lowering group acquired the available images.The volume of infarction was increased both in these two groups,there was no significant difference in the increased values[(13.21 ± 9.51)cm3 vs(12.95 ± 9.68)cm3,P=0.891].There was no statiatical differences in the volume of hypoperfusion,reperfusion rate,neurologic function at early stage,the mRS scores and mortality at 90d,the incidence of sICH either(P>0.05)except the rate of HT(9.4%vs 23.1%,P=0.049).Conclusion:Early intensive BP-lowering treatment has no adverse effects on the transformation of ischemic penumbra and prognosis after intravenous thrombolysis in patients with acute ischemic stroke and may decrease the the rate of HT in some degree.