Effect of Blood Pressure Augmentation on CVA Patients who are out of Injection TPA (Tissue Plasminogen Activator) and Mechanical Thrombectomy Window

Abstract

Background: Ischemic stroke is a leading cause of morbidity and mortality worldwide, prompting an urgent need for effective treatments outside the standard therapeutic window. With an estimated 6.5 million stroke-related deaths annually and a particular prevalence in the 18-49 age demographic, there is a substantial burden on healthcare systems. Intravenous thrombolysis and mechanical thrombectomy are time-sensitive treatments that are not universally accessible, highlighting the need for alternative strategies.

Objective: The study aimed to evaluate the efficacy of induced hypertension as a therapeutic intervention for ischemic stroke patients who are beyond the window for conventional reperfusion therapies.

Methods: This cross-sectional observational study was conducted at the Hyper Acute Stroke Unit (HASU) of PEMH, Rawalpindi. Over four months, 50 male patients who had suffered an ischemic stroke and were outside the therapeutic window for TPA and mechanical thrombectomy were recruited. Induced hypertension was achieved through intravenous administration of norepinephrine, titrated to maintain systolic blood pressure between 180-200 mmHg. Blood pressure was recorded at baseline, immediately before norepinephrine administration, and every 12 hours thereafter. Muscle power was assessed using the Medical Research Council (MRC) scale at 24-hour intervals over a 3-day observational period.

Results: The mean systolic blood pressure was 140±5.07 mmHg, and the mean diastolic blood pressure was 94.16±4.71 mmHg, with a mean patient age of 55±4.4 years. Following induced hypertension, 30 out of the 50 patients (60%) showed improvement in muscle power. Specifically, in Group 1 (6 patients with leg muscle weakness), 3 patients improved from an MRC scale of 2 to 3, and 1 patient improved from an MRC scale of 3 to 4. In Group 2 (15 patients with upper and lower limb weakness), 7 patients improved from an MRC scale of 2 to 3, and 4 patients improved from an MRC scale of 3 to 4. Similar improvements were observed in other groups, with overall improvements ranging from 37.5% to 80% within individual subgroups.

Conclusion: Induced hypertension via norepinephrine infusion appears to be a promising therapeutic strategy to improve muscle power in ischemic stroke patients who cannot receive standard reperfusion treatments. This intervention could potentially bridge the treatment gap for patients who present outside of the traditional therapeutic time frame.