Objective:

To determine whether cardiovascular hemodynamic measures can serve as physiologic biomarkers for early identification of acute ischemic stroke patients at risk for high blood pressure variability (BPV) and impaired cerebral autoregulation.

Background:

Both elevated BPV and impaired cerebral autoregulation are independently associated with worse functional outcomes after acute ischemic stroke. Perturbations in systemic hemodynamics, such as reduced cardiac output or intravascular volume depletion, can destabilize cerebral perfusion, leading to increased BPV and compromised autoregulatory capacity. Characterizing these relationships may enable physiologically informed risk stratification and individualized blood pressure management in the acute stroke setting.

Design/Methods:

From a prospectively maintained stroke database, we identified 42 patients who underwent 24-hour continuous physiologic monitoring after thrombectomy. Cerebral autoregulation was assessed using a NIRS-derived cerebral oxygenation index to calculate the optimal mean arterial pressure (MAPopt). The average absolute deviation of MAP from MAPopt and BPV (standard deviation of MAP) were computed over 24 hours. Linear regression analyses examined relationships between cardiac index (CI), BPV, and MAPopt deviation, with additional analyses focused on the first 6 hours post-reperfusion.

Results:

Over 24 hours following reperfusion, lower CI was associated with greater deviation of MAP from MAPopt (B = -1.79, p = 0.03) and showed a non-significant inverse relationship with BPV (B = -1.19, p = 0.10). Lower CI predicted higher BPV (B = -2.25, p = 0.03) and greater deviation from MAPopt during the first 6 hours after reperfusion (B = -3.33, p = 0.03).

Conclusions:

In this preliminary analysis of acute ischemic stroke patients, lower CI was associated with higher BPV and greater deviation from autoregulation-based optimal blood pressure targets, both linked to worse functional outcomes. CI may therefore represent a physiologic biomarker for early identification of high-risk stroke patients and a potential target for hemodynamic optimization.