AUTHOR=Sim Jae Eun , Chung Jong-Won , Seo Woo-Keun , Bang Oh Young , Kim Gyeong-Moon 

TITLE=Association of Systolic Blood Pressure and Cerebral Collateral Flow in Acute Ischemic Stroke by Stroke Subtype

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.863483

DOI=10.3389/fneur.2022.863483

ISSN=1664-2295

ABSTRACT=<sec><title>Background and Purpose</title><p>Collateral flow in acute ischemic stroke is known as a predictor of treatment outcome and long-term prognosis. However, factors determining the initial collateral flow remain unclear. We investigated factors related to collateral flow in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO) and further analyzed the results according to stroke etiology.</p></sec><sec><title>Methods</title><p>This was a retrospective study using prospective stroke registry data from a single university hospital from October 2014 to May 2021. AIS-LVO with middle cerebral artery M1 occlusion identified by pre-treatment multiphasic computed tomography angiography was included. Collateral flow score was graded on a 6-point ordinal scale according to pial arterial filling.</p></sec><sec><title>Results</title><p>A total of 74 patients [cardioembolism (CE): 57; large artery atherosclerosis (LAA): 17] was included. The mean age of all patients was 72.2 ± 11.7 years, and 37.8 % (<italic>n</italic> = 28) were men. Multivariate regression analysis showed that initial SBP [odds ratio (OR): 0.994; 95% confidence interval (<italic>CI</italic>): 0.990–0.998; <italic>p</italic> = 0.002] and stroke etiology (<italic>OR</italic>: 0.718; 95% <italic>CI</italic>: 0.548–0.940; <italic>p</italic> = 0.019) were independent factors of the collateral flow grade. Collateral flow grade was independently associated with initial SBP in the CE group (<italic>OR</italic>: 0.993; 95% <italic>CI</italic>: 0.989–0.998; <italic>p</italic> = 0.004) but not in the LAA group (<italic>OR</italic>: 0.992; 95% <italic>CI</italic>: 0.980–1.004; <italic>p</italic> = 0.218). Initial SBP was significantly correlated with NIHSS score in the CE group but not in the LAA group (<italic>r</italic><sup>2</sup>= 0.091, <italic>p</italic> = 0.023; <italic>r</italic><sup>2</sup> = 0.043, <italic>p</italic> = 0.426, respectively).</p></sec><sec><title>Conclusions</title><p>Elevated initial SBP was associated with poor cerebral collateral flow and more severe symptoms in the CE group, but not in the LAA group in patients with AIS-LVO. These findings suggest differential effects of initial SBP elevation on collateral flow by stroke subtypes.</p></sec>