Integrative physiological assessment of cerebral hemodynamics and metabolism in acute ischemic stroke.
Jui-Lin FanRicardo de Carvalho NogueiraPatrice BrassardCaroline A RickardsMatthew PageNathalie NasrYu-Chieh TzengPublished in: Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism (2021)
Restoring perfusion to ischemic tissue is the primary goal of acute ischemic stroke care, yet only a small portion of patients receive reperfusion treatment. Since blood pressure (BP) is an important determinant of cerebral perfusion, effective BP management could facilitate reperfusion. But how BP should be managed in very early phase of ischemic stroke remains a contentious issue, due to the lack of clear evidence. Given the complex relationship between BP and cerebral blood flow (CBF)-termed cerebral autoregulation (CA)-bedside monitoring of cerebral perfusion and oxygenation could help guide BP management, thereby improve stroke patient outcome. The aim of INFOMATAS is to 'identify novel therapeutic targets for treatment and management in acute ischemic stroke'. In this review, we identify novel physiological parameters which could be used to guide BP management in acute stroke, and explore methodologies for monitoring them at the bedside. We outline the challenges in translating these potential prognostic markers into clinical use.
Keyphrases
- cerebral ischemia
- cerebral blood flow
- acute ischemic stroke
- subarachnoid hemorrhage
- blood pressure
- atrial fibrillation
- end stage renal disease
- brain injury
- palliative care
- acute myocardial infarction
- chronic kidney disease
- computed tomography
- risk assessment
- climate change
- magnetic resonance
- oxidative stress
- metabolic syndrome
- combination therapy
- heart failure
- acute coronary syndrome
- patient reported outcomes
- patient reported
- weight loss
- skeletal muscle
- replacement therapy
- health insurance
- affordable care act