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Nitroglycerin Is Not Associated with Improved Cerebral Perfusion in Acute Ischemic Stroke.
Can J Neurol Sci. 2021 05; 48(3):349-357.CJ

Abstract

OBJECTIVE

The study was conducted to test the hypothesis that nitroglycerin (NTG) increases cerebral perfusion focally and globally in acute ischemic stroke patients, using serial perfusion-weighted imaging (PWI) magnetic resonance imaging measurements.

PATIENTS AND METHODS

Thirty-five patients underwent PWI immediately before and 72 h after administration of a transdermal NTG patch or no treatment. Patients with baseline mean arterial pressure (MAP) > 100 mmHg (NTG group, n = 20) were treated with transdermal NTG (0.2 mg/h) for 72 h, without a nitrate-free interval. Patients with MAP ≤ 100 mmHg (untreated group, n = 15) were not treated. The primary outcome measure was absolute cerebral blood flow (CBF) in the hypoperfused region at 72 h.

RESULTS

The mean baseline absolute CBF in the hypoperfused region was similar in the NTG group (33.3 ± 10.2 ml/100 g/min) and untreated (32.7 ± 8.4 ml/100 g/min, p = 0.4) groups. The median (IQR) baseline infarct volume was 10.4 (2.5-49.3) ml in the NTG group and 32.6 (8.6-96.7) ml in the untreated group (p = 0.09). MAP change in the NTG group was 1.2 ± 12.6 and 8 ± 20.7 mmHg at 2 h and 72 h, respectively. Mean absolute CBF in the hypoperfused region at 72 h was similar in the NTG (29.9 ± 12 ml/100 g/min) and untreated groups (24.1 ± 10 ml/100 g/min, p = 0.8). The median infarct volume increased in untreated (11.8 (5.7-44.2) ml) than the NTG group (3.2 (0.5-16.5) ml; p = 0.033) on univariate analysis, however, there was no difference on regression analysis.

CONCLUSION

NTG was not associated with improvement in cerebral perfusion in acute ischemic stroke patients.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Division of Neurology, University of Alberta, Edmonton, Canada.

Division of Neurology, University of Alberta, Edmonton, Canada.

Department of Neurology, University of Miami, Miami, USA.

Division of Neurology, University of Alberta, Edmonton, Canada.

Division of Neurology, University of Alberta, Edmonton, Canada.

Division of Neurology, University of Alberta, Edmonton, Canada.

Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada.

Department of Biomedical Engineering, University of Alberta, Edmonton, Canada.

Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.

MeSH

Brain IschemiaCerebrovascular CirculationHumansIschemic StrokeNitroglycerinPerfusionStroke

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32799944

Citation

Kate, Mahesh, et al. "Nitroglycerin Is Not Associated With Improved Cerebral Perfusion in Acute Ischemic Stroke." The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques, vol. 48, no. 3, 2021, pp. 349-357.

Kate M, Gioia L, Asdaghi N, et al. Nitroglycerin Is Not Associated with Improved Cerebral Perfusion in Acute Ischemic Stroke. Can J Neurol Sci. 2021;48(3):349-357.

Kate, M., Gioia, L., Asdaghi, N., Jeerakathil, T., Shuaib, A., Buck, B., Emery, D., Beaulieu, C., & Butcher, K. (2021). Nitroglycerin Is Not Associated with Improved Cerebral Perfusion in Acute Ischemic Stroke. The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques, 48(3), 349-357. https://doi.org/10.1017/cjn.2020.179

Kate M, et al. Nitroglycerin Is Not Associated With Improved Cerebral Perfusion in Acute Ischemic Stroke. Can J Neurol Sci. 2021;48(3):349-357. PubMed PMID: 32799944.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Nitroglycerin Is Not Associated with Improved Cerebral Perfusion in Acute Ischemic Stroke. AU - Kate,Mahesh, AU - Gioia,Laura, AU - Asdaghi,Negar, AU - Jeerakathil,Thomas, AU - Shuaib,Ashfaq, AU - Buck,Brian, AU - Emery,Derek, AU - Beaulieu,Christian, AU - Butcher,Kenneth, Y1 - 2020/08/17/ PY - 2020/8/18/pubmed PY - 2021/9/30/medline PY - 2020/8/18/entrez KW - Blood pressure KW - Cerebral perfusion KW - Diffusion MRI KW - Ischemic stroke KW - Nitroglycerin KW - Perfusion-weighted MRI SP - 349 EP - 357 JF - The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques JO - Can J Neurol Sci VL - 48 IS - 3 N2 - OBJECTIVE: The study was conducted to test the hypothesis that nitroglycerin (NTG) increases cerebral perfusion focally and globally in acute ischemic stroke patients, using serial perfusion-weighted imaging (PWI) magnetic resonance imaging measurements. PATIENTS AND METHODS: Thirty-five patients underwent PWI immediately before and 72 h after administration of a transdermal NTG patch or no treatment. Patients with baseline mean arterial pressure (MAP) > 100 mmHg (NTG group, n = 20) were treated with transdermal NTG (0.2 mg/h) for 72 h, without a nitrate-free interval. Patients with MAP ≤ 100 mmHg (untreated group, n = 15) were not treated. The primary outcome measure was absolute cerebral blood flow (CBF) in the hypoperfused region at 72 h. RESULTS: The mean baseline absolute CBF in the hypoperfused region was similar in the NTG group (33.3 ± 10.2 ml/100 g/min) and untreated (32.7 ± 8.4 ml/100 g/min, p = 0.4) groups. The median (IQR) baseline infarct volume was 10.4 (2.5-49.3) ml in the NTG group and 32.6 (8.6-96.7) ml in the untreated group (p = 0.09). MAP change in the NTG group was 1.2 ± 12.6 and 8 ± 20.7 mmHg at 2 h and 72 h, respectively. Mean absolute CBF in the hypoperfused region at 72 h was similar in the NTG (29.9 ± 12 ml/100 g/min) and untreated groups (24.1 ± 10 ml/100 g/min, p = 0.8). The median infarct volume increased in untreated (11.8 (5.7-44.2) ml) than the NTG group (3.2 (0.5-16.5) ml; p = 0.033) on univariate analysis, however, there was no difference on regression analysis. CONCLUSION: NTG was not associated with improvement in cerebral perfusion in acute ischemic stroke patients. SN - 0317-1671 UR - https://www.unboundmedicine.com/medline/citation/32799944/Nitroglycerin_Is_Not_Associated_with_Improved_Cerebral_Perfusion_in_Acute_Ischemic_Stroke_ DB - PRIME DP - Unbound Medicine ER -