Nitroglycerin Is Not Associated with Improved Cerebral Perfusion in Acute Ischemic Stroke

Mahesh Kate, Laura Gioia, Negar Asdaghi, Thomas Jeerakathil, Ashfaq Shuaib, Brian Buck, Derek Emery, Christian Beaulieu, Kenneth Butcher

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The study was conducted to test the hypothesis that nitroglycerin (NTG) increases cerebral perfusion focally and globally in acute ischemic stroke patients, using serial perfusion-weighted imaging (PWI) magnetic resonance imaging measurements. Patients and methods: Thirty-five patients underwent PWI immediately before and 72 h after administration of a transdermal NTG patch or no treatment. Patients with baseline mean arterial pressure (MAP) > 100 mmHg (NTG group, n = 20) were treated with transdermal NTG (0.2 mg/h) for 72 h, without a nitrate-free interval. Patients with MAP ≤ 100 mmHg (untreated group, n = 15) were not treated. The primary outcome measure was absolute cerebral blood flow (CBF) in the hypoperfused region at 72 h. Results: The mean baseline absolute CBF in the hypoperfused region was similar in the NTG group (33.3 ± 10.2 ml/100 g/min) and untreated (32.7 ± 8.4 ml/100 g/min, p = 0.4) groups. The median (IQR) baseline infarct volume was 10.4 (2.5-49.3) ml in the NTG group and 32.6 (8.6-96.7) ml in the untreated group (p = 0.09). MAP change in the NTG group was 1.2 ± 12.6 and 8 ± 20.7 mmHg at 2 h and 72 h, respectively. Mean absolute CBF in the hypoperfused region at 72 h was similar in the NTG (29.9 ± 12 ml/100 g/min) and untreated groups (24.1 ± 10 ml/100 g/min, p = 0.8). The median infarct volume increased in untreated (11.8 (5.7-44.2) ml) than the NTG group (3.2 (0.5-16.5) ml; p = 0.033) on univariate analysis, however, there was no difference on regression analysis. Conclusion: NTG was not associated with improvement in cerebral perfusion in acute ischemic stroke patients.

Original languageEnglish (US)
Pages (from-to)349-357
Number of pages9
JournalCanadian Journal of Neurological Sciences
Volume48
Issue number3
DOIs
StatePublished - May 2021

Keywords

  • Blood pressure
  • Cerebral perfusion
  • Diffusion MRI
  • Ischemic stroke
  • Nitroglycerin
  • Perfusion-weighted MRI

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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