Comparison of efficacy and safety of induced hypertension and anticoagulation for rescue therapy of early neurological deterioration in the lacunar stroke patients

초록

Background : Early neurological deterioration (END) can occurfrequently in patients with acute ischemic stroke with aggressive stroke symptomsand poor prognosis. When END occur, clinicians apply various treatment forimproving END. This study aims to investigate which treatments are successful asrescue therapy when END has occurred in patients with lacunar stroke. Methods : Lacunar stroke patients within 7 days of symptom onset with END during72 hours were treated with therapeutic induced hypertension or anticoagulation groups. In the induced hypertension group, phenylephrine was administered intravenously and tapered off (10 mL/h) after 24 hours with neurologic stabilizationor after using 4 days. In the anticoagulation group, argatroban was administeredintravenously for 4 days. The primary endpoint was END recovery (decrease in NIHSSover 2 points or improved motor symptoms during the first 7 days). The secondaryendpoint was the proportion of excellent functional outcomes (mRS 0?1) at 3months. Safety outcomes included symptomatic intracranial hemorrhage/edema,myocardial infarction, and death. Results : 79 and 68 patients were included in the pharmacological inducedhypertension and anticoagulation groups, respectively. Therapeutic inducedhypertension increased the END recovery (77.2% vs. 51.5%, P<0.01) and excellentfunctional outcome (mRS 0-1, 34.2% vs. 16.2%, P=0.04). After adjustment, induced hypertension (2.49 OR; 95% CI 1.06?5.81, P=0.04) and younger age were associated with END recovery. Conclusions : Among lacunar stroke patients with END, therapeutic inducedhypertension was safe and effective, showing excellent results in END recovery andfunctional independence at 3 months