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Case Report/Case Series
December 2014

Association Between Neurologic Improvement With Decline in Blood Pressure and Recanalization in Stroke

Author Affiliations
  • 1Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
  • 2University of Iowa, Iowa City
  • 3University of Texas Southwestern Medical Center, Austin
  • 4MedStar Washington Hospital Center, Washington, DC
  • 5National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
  • 6Johns Hopkins Community Physicians, Bethesda, Maryland
JAMA Neurol. 2014;71(12):1555-1558. doi:10.1001/jamaneurol.2014.2036
Abstract

Importance  Patients with stroke often have a decline in blood pressure after thrombolysis. Neurologic improvement could result from recanalization or better collateral flow despite persistent occlusion. We hypothesized that neurologic improvement with concurrent decline in blood pressure may be a clinical sign of recanalization after intravenous tissue plasminogen activator.

Observations  Patients treated with intravenous tissue plasminogen activator at Suburban Hospital, Bethesda, Maryland, and MedStar Washington Hospital Center, Washington, DC, from 1999 to 2009 were included in the study if they had pretreatment and 24-hour magnetic resonance angiographic scans, National Institutes of Health Stroke Scale scores at those times, and proximal middle cerebral artery occlusion demonstrated prior to treatment. The recanalization status on 24-hour magnetic resonance angiography was classified as none, partial, or complete. Seventeen patients met study criteria. On 24-hour magnetic resonance angiography, 3 patients had no recanalization, 8 had partial recanalization, and 6 had complete recanalization. At 24 hours after thrombolysis, neurologic improvement with concurrent decline in systolic blood pressure of 20 mm Hg or greater was seen in 4 patients with partial recanalization, 4 patients with complete recanalization, and none of the patients with no recanalization.

Conclusions and Relevance  Neurologic improvement with concurrent decline in systolic blood pressure of 20 mm Hg or greater after intravenous tissue plasminogen activator may be a clinical sign of recanalization. This observation needs confirmation in a larger cohort.

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