Page 547

Karger_ESC London_2013

London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 547 488 Vascular biology The prevalence of abnormal microvascular response (peaks) in stroke or transient ischaemic attack (TIA) patients compared with Controls and association with impaired sympathetic ac-tivity. D.D. Adingupu1, S. Elyas2, C.E. Thorn3, P.E. Gates4, A.C. Shore5, W.D. Strain6 Diabetes and Vascular Medicine, University of Exeter Medical School, Exeter, UNITED KINGDOM1, Diabetes and Vascular Medicine, University of Exeter Medical School, Exeter, UNIT-ED KINGDOM2, Diabetes and Vascular Medicine, University of Exeter Medical School, Exeter, UNITED KINGDOM3, Diabetes and Vascular Medicine, University of Exeter Medical School, Ex-eter, UNITED KINGDOM4, Diabetes and Vascular Medicine, University of Exeter Medical School, Exeter, UNITED KINGDOM5, Diabetes and Vascular Medicine, University of Exeter Medical School, Exeter, UNITED KINGDOM6 Introduction: We have previously demonstrated a distinct microvascular autoregulatory abnormali-ty (reperfusion peaks) in response to post occlusive reactive hyperaemia (PORH) in the skin which is associated with higher cardiovascular risk. We explored the prevalence of abnormal reperfusion peaks in patients following stroke/ TIA compared to apparently healthy controls and the components of vasomotion in those with abnormal versus normal peak responses. Methods: PORH was performed on 100 patients who had suffered stroke or TIA in the previous 6 months and 83 controls. Following 17-minutes of resting vascular perfusion reactive hyperaemia was induced using a 4-minute arterial occlusion of the ankle. Laser Doppler fluximetry was used to record perfusion; resting flux was analysed using fast-Fourier transformation. The proportion of vasomotor response attributed to endothelial function (0.001-0.02Hz), sympathetic tone (0.021- 0.05Hz) and myogenic tone (0.051-0.15Hz) were calculated as a percentage of the total vasomotor response. Results: Baseline characteristics were similar between the groups. Patients with TIA/Stroke had a higher prevalence of abnormal peaks compared to controls (72 vs. 51 %, p=0.003). After adjusting for age, blood pressure, heart rate, gender and BMI, the sympathetic component of vasomotion was significantly attenuated in those with abnormal reperfusion peaks compared with normal peaks. This was true in strokes and controls geometric mean (95% CI) 8.31 (7.09 to 9.74) vs. 12.45 (9.30 to 16.65) (p=0.02) and 8.40 (6.47 to 10.91) vs. 12.58 (9.25 to 17.12) (p=0.042). Conclusion: Patients with stroke/TIA have a higher prevalence of abnormal microvascular autoregu-latory response compared to healthy controls. Abnormal peak response is associated with attenuated sympathetic component of vasomotion. This suggests a potential mechanism by which skin autoreg-ulation predicts target organ damage. 489 Vascular biology Symptomatic Hemispheric Hyperperfusion after Intravenous Thrombolysis for Acute Isch-emic Stroke V.K. Sharma1, P.R. Paliwal2, H.L. Teoh3, E.Y. Ting4, R.C. Seet5, B.P.L. Chan6 National University of Singapore, Singapore, SINGAPORE1, National University Health System, Singapore, SINGAPORE2, National University Health System, Singapore, SINGAPORE3, National University Health System, Singapore, SINGAPORE4, National University of Singapore, Singapore, SINGAPORE5, National University Health System, Singapore, SINGAPORE6 Background and aim- Intravenous tissue plasminogen activator (IV-tPA)-induced arterial recanali-zation often results in rapid clinical recovery in acute ischemic stroke (AIS). However, rapid arterial recanalization can rarely lead to cerebral hyperperfusion syndrome (HPS) with variable presenta-tions. HPS is a recognized entity after recanalization of a chronically occluded artery, probably due to failed cerebral autoregulation. We present an AIS case that developed symptomatic hemispheric HPS after successful thrombolysis Case Description- A 43 year old hypertensive lady presented with sudden left hemiplegia (NI-HSS score 19-points). Non-contrast brain CT was unremarkable but CT angiogram (CTA) showed non-opacification of right middle cerebral (MCA) and internal carotid artery (ICA). IV-tPA resulted in complete recanalization of MCA and ICA, accompanied by clinical recovery (NIHSS at 2-hours 3-points). However, she deteriorated gradually (NIHSS at 18 hours 9-points). No bleeding or acute infarct was seen on repeat CT brain. Repeat CTA showed complete recanalisation of ICA and MCA. This unexpected neurological deterioration prompted us to explore further. Quantitative electroen-cephalography (QEEG) showed considerable right hemispheric slowing and CT perfusion (CTP) re-vealed paradoxical significant right hemispheric hyperperfusion. Head-up position, fluid restriction and BP control (target 120/80mmHg) resulted in gradual clinical recovery (day-7 NIHSS 1-point). CTP and QEEG, performed on day 9, revealed normalization of their respective findings. She had achieved complete clinical recovery when seen at 3-months. Conclusions- HPS should be considered in AIS with mismatch between the clinico-radiological find-ings. Timely diagnosis and appropriate management may avert the harmful sequel of this condition. We hypothesized that regional hyperperfusion led to the paradoxically reduced neuronal activity (neurovascular uncoupling), manifesting as neurological deterioration.


Karger_ESC London_2013
To see the actual publication please follow the link above