| Objectives To evaluate the safety and efficacy of induced hypertension in patients with acute anterior circulation cerebral infarction.Methods Forty-seven patients with acute anterior circulation cerebral infarction who were hospitalizehd within 48 hours and were ineligible for revascularization therapy in Tangshan Workers Hospital affiliated to North China University of Science and Technology from August 2019 to December 2020 were selected.All patients were demonstrated by MRA or CTA to have symptomatic macrovascular stenosis,a ratio of the maximum area of ischemic tissue on perfusion imaging to infarct maximum area of 20%or more,and NIHSS score was in 5-15 points,systolic blood pressure(SBP)≤160/100mm Hg at baseline.All patients were randomly assigned(1:1)to the hypertension and control group.Maximal variability of systolic blood pressure during dopamine hydrochloride application was within 10%-20%of the target values,and maintain the hypertension level for 48 hours,in addition to it was given routine treatment such as antithrombotic,lipid-lowering,and stable plaques meanwhile,the control group was only given routine treatment.Safety outcomes included adverse events such as headache,arrhythmia,renal injury and dyspnea occurred within 7 days after treatment,and it was unsafe for patients who could not continue to test or have cerebral hemorrhage,intracranial hemorrhage or death after treatment;it is safe for those who can continue the trial or have no adverse events after the treatment of adverse events.The short-term treatment effectiveness was early neurologic improvement(NIHSS score≥2 points during the first 14 days).The values of CBF,rCBF and rCBF(PLD=2525ms-1525ms)were compared between the two groups 14 days after treatment to evaluate the improvement of cerebral perfusion and cerebral collateral circulation.The Long-term prognosis evaluation good was a modified Rankin Scale score of 0 to 2 at 90 days.Results A total of 43 patients were enrolled in the study.there was no significant difference in age,sex,onset-admission time,maximum infarct area,maximum low perfusion area,MRA vascular severity and risk factors of cerebrovascular disease between the two groups.Safety outcomes did not significantly differ between groups.the short-term effective rate was 28.6%(6/21)in the hypertension group and 20.9%(3/22)in the control group at 14 days after treatment,and there was no significant difference between the two groups(P>0.05).Short-term efficacy evaluation(ASL-CBF)was the CBF(PLD=1525ms),CBF(PLD=2525ms)and rCBF of the affected side in the hypertension group were significantly higher than those in the control group(P<0.05),but there was no significant difference in CBF and rCBF between the two groups(P>0.05)at 14 days after treatment.The rCBF value(PLD=2525ms-1525ms)in the hypertension group and the control group was(0.09±0.08)and(0.06±0.05)respectively after 14 days of treatment,and there was no significant difference between the two groups(P>0.05).Long-term prognosis evaluation was the rate of good prognosis in the pressor group was 52.4%(11/21),which was significantly higher than that in the control group 22.7%(5/22)at 90 days,the difference was statistically significant(χ~2=4.044,P=0.044).Conclusions DWI/ASL mismatch 48 hours after onset in patients with acute anterior circulation cerebral infarction with internal carotid or middle cerebral artery stenosis or occlusion:1 Induced hypertension may not increase the risk of adverse events and cerebral hemorrhage,intracranial hemorrhage and death.2 Induced hypertension can not significantly increase the effective rate of short-term treatment,but can significantly increase the rate of good neurological function for 90 days.3 Induced hypertension can significantly improve the short-term cerebral perfusion of the affected side,but can not significantly improve the compensatory ability of lateral branches.Figure3;Table9;Reference 164... |
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