Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, December 7, 2020

Prognostic significance of early systolic blood pressure variability after endovascular thrombectomy and intravenous thrombolysis in acute ischemic stroke: A systematic review and meta‐analysis

 So we still have no protocol on what should be done. Hope you are OK with your doctor guessing what to do?

Prognostic significance of early systolic blood pressure variability after endovascular thrombectomy and intravenous thrombolysis in acute ischemic stroke: A systematic review and meta‐analysis

First published: 14 October 2020
https://doi.org/10.1002/brb3.1898

Abstract

Objectives

Previous studies have shown inconsistent results regarding the effect of early systolic blood pressure variability (SBPV) after endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) on functional outcome in acute ischemic stroke (AIS). The systematic review and meta‐analysis aimed to determine the effect of early SBPV after EVT and IVT on outcome in AIS.

Materials and Methods

We searched for articles published before February 2020 in the following databases: PubMed, Web of Science, EMBASE, Medline, and Google Scholar. The pooled multivariate odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs) were obtained using STATA 13.0 software.

Results

Increased early SBPV after EVT was significantly associated with worse functional outcome in AIS (OR = 1.42, 95% CI 1.02 to 1.99, I2 = 82.4%, p value of Q test < .001), whereas no significant associations were indicated between SBPV after IVT and functional outcome, symptomatic intracerebral hemorrhage (sICH) in AIS [functional outcome: RR = 1.08, 95% CI 0.96 to 1.22, I2 = 0.0%, p value of Q test = 0.793; sICH: RR = 2.40, 95% CI 0.71 to 8.03, I2 = 78.2%, p value of Q test = 0.01].

Conclusions

The present study provided evidence that increased early SBPV after EVT is related to worse longer‐term functional outcome in AIS, but the association is not significant in AIS patients treated with IVT. Furthermore, individualized BP management strategies were essential for AIS patients after EVT or IVT.

1 INTRODUCTION

Previous studies indicated that functional outcome after ischemic stroke (IS) is influenced by some factors including stroke severity, age, initial glucose, and time to and success of recanalization (Jauch et al., 2013; Powers et al., 2015). Systolic blood pressure variability (SBPV), independent of mean absolute BP level, is also an important factor to the outcome of acute ischemic stroke (AIS) (Rothwell, 2010; Rothwell et al., 2010). However, controversial results have been obtained from studies regarding BP management and its influence on functional outcome (Bennett et al., 2018). A recent systematic review and meta‐analysis showed that increased BPV in AIS might be related to worse functional outcome (Manning et al., 2015). Two studies indicated that worse outcomes with increased BPV might be attributed to increases in infarct volume (Delgado‐Mederos et al., 2008; Endo et al., 2013). Cerebral blood flow reperfusion, the clinical goal of endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT), is closely associated with better prognosis in AIS (Coutinho et al., 2017; Fjetland et al., 2015). Regarding the effect of early BPV after EVT and IVT on functional outcome in AIS, previous studies showed inconsistent results. Bennett et al. (2018) indicated that increased BPV after EVT predicts worse neurologic outcomes in patients with AIS. However, some studies showed no significant associations between early BPV after EVT (Cho & Kim, 2019) or IVT (Tomii et al., 2011) and functional outcome. The study aimed to determine the effect of early SBPV after EVT and IVT on outcome in AIS by undertaking a systematic review and meta‐analysis.

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