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Detrimental Effect of Chronic Hypertension on Leptomeningeal Collateral Flow in Acute Ischemic Stroke.

Abstract

Background and Purpose- We aimed to evaluate the effect of chronic hypertension on acute leptomeningeal collateral flow in patients with large-vessel ischemic stroke using digital subtraction angiography, which is the gold standard for the assessment of collateral circulation. Methods- Of the consecutive ischemic stroke patients from October 2011 to December 2017 seen in our institution, patients with acute occlusion of the M1 segment of the middle cerebral artery confirmed on initial digital subtraction angiography were enrolled. Chronic hypertension was defined as its documentation before the index stroke or as the administration of antihypertensive medications before onset. Angiographic leptomeningeal collateral flow was evaluated according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Flow Grading System and dichotomized the findings into excellent (grade 3-4) or poor (grade 0-2) collateral status for analysis. Results- Of the 3759 consecutive ischemic stroke patients, 100 patients were analyzed. Thirty-nine patients (39%) had poor collateral status. Patients with poor collateral status were older, more frequently male, and had chronic hypertension more frequently, shorter time from onset to angiography, and higher admission systolic blood pressure than those with excellent collateral status. Multivariable logistic analysis with prespecified covariates showed a significantly positive association between chronic hypertension and poor collateral status (odds ratio, 2.80; 95% CI, 1.08-7.70; P=0.034). This association was independent of admission systolic blood pressure. The proportion of patients with poor collateral status increased in a stepwise manner in patients without chronic hypertension, hypertensive patients with premorbid antihypertensive medications, and hypertensive patients without antihypertensive medications (P for trend <0.001). Conclusions- Our data suggest that chronic hypertension has a detrimental effect on acute leptomeningeal collateral flow in patients with cerebral large-vessel occlusion. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02251665.

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  • Authors+Show Affiliations

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    From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan. Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan (K.F., T.Y.).

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    Division of Stroke Care Unit (K. Tanaka, H.Y., K.S.), National Cerebral and Cardiovascular Center, Suita, Japan.

    ,

    Division of Stroke Care Unit (K. Tanaka, H.Y., K.S.), National Cerebral and Cardiovascular Center, Suita, Japan.

    ,

    From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan. Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan (T.I.).

    ,

    Department of Neurology (H.I., M.I.), National Cerebral and Cardiovascular Center, Suita, Japan.

    ,

    Division of Stroke Care Unit (K. Tanaka, H.Y., K.S.), National Cerebral and Cardiovascular Center, Suita, Japan.

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    Department of Neurosurgery (T.S., J.C.T.), National Cerebral and Cardiovascular Center, Suita, Japan.

    ,

    Department of Neurosurgery (T.S., J.C.T.), National Cerebral and Cardiovascular Center, Suita, Japan.

    ,

    Department of Neurology (H.I., M.I.), National Cerebral and Cardiovascular Center, Suita, Japan.

    ,

    From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan.

    ,

    Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan (K.F., T.Y.).

    From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan.

    Source

    Stroke 50:7 2019 Jul pg 1751-1757

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31233392

    Citation

    Fujita, Kyohei, et al. "Detrimental Effect of Chronic Hypertension On Leptomeningeal Collateral Flow in Acute Ischemic Stroke." Stroke, vol. 50, no. 7, 2019, pp. 1751-1757.
    Fujita K, Tanaka K, Yamagami H, et al. Detrimental Effect of Chronic Hypertension on Leptomeningeal Collateral Flow in Acute Ischemic Stroke. Stroke. 2019;50(7):1751-1757.
    Fujita, K., Tanaka, K., Yamagami, H., Ide, T., Ishiyama, H., Sonoda, K., ... Toyoda, K. (2019). Detrimental Effect of Chronic Hypertension on Leptomeningeal Collateral Flow in Acute Ischemic Stroke. Stroke, 50(7), pp. 1751-1757. doi:10.1161/STROKEAHA.119.025142.
    Fujita K, et al. Detrimental Effect of Chronic Hypertension On Leptomeningeal Collateral Flow in Acute Ischemic Stroke. Stroke. 2019;50(7):1751-1757. PubMed PMID: 31233392.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Detrimental Effect of Chronic Hypertension on Leptomeningeal Collateral Flow in Acute Ischemic Stroke. AU - Fujita,Kyohei, AU - Tanaka,Kanta, AU - Yamagami,Hiroshi, AU - Ide,Toshihiro, AU - Ishiyama,Hiroyuki, AU - Sonoda,Kazutaka, AU - Satow,Tetsu, AU - Takahashi,Jun C, AU - Ihara,Masafumi, AU - Koga,Masatoshi, AU - Yokota,Takanori, AU - Toyoda,Kazunori, Y1 - 2019/05/16/ PY - 2019/6/25/entrez PY - 2019/6/25/pubmed PY - 2019/6/25/medline KW - angiography KW - antihypertensive agent KW - blood pressure KW - collateral circulation KW - hypertension KW - stroke SP - 1751 EP - 1757 JF - Stroke JO - Stroke VL - 50 IS - 7 N2 - Background and Purpose- We aimed to evaluate the effect of chronic hypertension on acute leptomeningeal collateral flow in patients with large-vessel ischemic stroke using digital subtraction angiography, which is the gold standard for the assessment of collateral circulation. Methods- Of the consecutive ischemic stroke patients from October 2011 to December 2017 seen in our institution, patients with acute occlusion of the M1 segment of the middle cerebral artery confirmed on initial digital subtraction angiography were enrolled. Chronic hypertension was defined as its documentation before the index stroke or as the administration of antihypertensive medications before onset. Angiographic leptomeningeal collateral flow was evaluated according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Flow Grading System and dichotomized the findings into excellent (grade 3-4) or poor (grade 0-2) collateral status for analysis. Results- Of the 3759 consecutive ischemic stroke patients, 100 patients were analyzed. Thirty-nine patients (39%) had poor collateral status. Patients with poor collateral status were older, more frequently male, and had chronic hypertension more frequently, shorter time from onset to angiography, and higher admission systolic blood pressure than those with excellent collateral status. Multivariable logistic analysis with prespecified covariates showed a significantly positive association between chronic hypertension and poor collateral status (odds ratio, 2.80; 95% CI, 1.08-7.70; P=0.034). This association was independent of admission systolic blood pressure. The proportion of patients with poor collateral status increased in a stepwise manner in patients without chronic hypertension, hypertensive patients with premorbid antihypertensive medications, and hypertensive patients without antihypertensive medications (P for trend <0.001). Conclusions- Our data suggest that chronic hypertension has a detrimental effect on acute leptomeningeal collateral flow in patients with cerebral large-vessel occlusion. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02251665. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/31233392/Detrimental_Effect_of_Chronic_Hypertension_on_Leptomeningeal_Collateral_Flow_in_Acute_Ischemic_Stroke L2 - http://www.ahajournals.org/doi/full/10.1161/STROKEAHA.119.025142?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -