Article
Clinical Neurology
Nicholas A. Morris, Gaurav Jindal, Seemant Chaturvedi
Summary: The optimal blood pressure targets following successful mechanical thrombectomy are still uncertain. Observational studies have shown conflicting results, suggesting either a U-shaped curve or a linear relationship between blood pressure and outcomes. Recent trials have not found a benefit to intensive blood pressure lowering, but there are concerns regarding their generalizability and safety. Further research is needed to determine the most appropriate approach.
Article
Clinical Neurology
Xia Wang, Jatinder S. Minhas, Tom J. Moullaali, Gian Luca Di Tanna, Richard Lindley, Xiaoying Chen, Hisatomi Arima, Guofang Chen, Candice Delcourt, Philip M. Bath, Joseph P. Broderick, Andrew M. Demchuk, Geoffrey A. Donnan, Alice C. Durham, Pablo M. Lavados, Tsong-Hai Lee, Christopher Levi, Sheila O. Martins, Veronica V. Olavarria, Jeyaraj D. Pandian, Mark W. Parsons, Octavio M. Pontes-Neto, Stefano Ricci, Shoichiro Sato, Vijay K. Sharma, Federico Silva, Nguyen H. Thang, Ji-Guang Wang, Mark Woodward, John Chalmers, Lili Song, Craig S. Anderson, Thompson G. Robinson
Summary: Post hoc analysis of thrombolyzed acute ischemic stroke patients showed that reducing systolic blood pressure and decreasing systolic blood pressure variability were associated with better recovery outcomes, while the magnitude of systolic blood pressure reduction did not affect the outcomes. Higher systolic blood pressure and greater systolic blood pressure variability were associated with an increased risk of intracranial hemorrhage.
Article
Clinical Neurology
Alastair J. S. Webb, David J. Werring
Summary: Despite advances in stroke management, hypertension remains a major risk factor for cerebrovascular disease. Blood pressure control is important, but doesn't fully prevent vascular cognitive impairment. The relationship between hypertension and cerebral blood flow control is not well understood. Increased blood pressure variability and changes in arterial stiffness may contribute to the risk of stroke. Targeting cerebral pulsatility and vascular reactivity in early clinical trials shows promise. The role of cerebral autoregulation as a modifiable risk factor is still uncertain. Understanding the pathophysiology of hypertension-related cerebrovascular disease may help prevent chronic cerebrovascular disease, acute events, and vascular cognitive impairment.
Article
Clinical Neurology
Noor Samuels, Rob A. van de Graaf, Carlijn A. L. van den Berg, Simone M. Uniken Venema, Kujtesa Bala, Pieter Jan van Doormaal, Wouter van der Steen, Elbert Witvoet, Jelis Boiten, Heleen den Hertog, Wouter J. Schonewille, Jeannette Hofmeijer, Floris Schreuder, Tobien A. H. C. M. L. Schreuder, H. Bart van der Worp, Yvo B. W. E. M. Roos, Charles B. L. M. Majoie, James F. Burke, Adriaan C. G. M. van Es, Aad van der Lugt, Bob Roozenbeek, Hester F. Lingsma, Diederik W. J. Dippel
Summary: This study assessed the association between systolic blood pressure (SBP) in the first 6 hours following endovascular treatment (EVT) for ischemic stroke and functional outcome as well as symptomatic intracranial hemorrhage. Results indicated that higher maximum SBP was associated with worse functional outcomes and increased risk of hemorrhage, while the association with minimum SBP was nonlinear with detrimental outcomes at both lower and higher levels. Successful reperfusion did not influence these relationships.
Article
Clinical Neurology
Linxin Li, Susanna M. Zuurbier, Wilhelm Kuker, Charles P. Warlow, Peter M. Rothwell
Summary: By comparing two colocated population-based studies, the research found a significant decrease in the risk of recurrent stroke after primary ICH over the past 40 years in Oxfordshire, coinciding with improvements in blood pressure control.
Article
Clinical Neurology
Hwan Seok Shim, Jeong-Mee Park, Yong Jae Lee, Young-Deok Kim, Tackeun Kim, Seung Pil Ban, Jae Seung Bang, O-Ki Kwon, Chang Wan Oh, Si Un Lee
Summary: Based on this observational study, blood pressure management is recommended for adults under the age of 65 years to prevent primary hemorrhagic stroke.
FRONTIERS IN NEUROLOGY
(2023)
Review
Clinical Neurology
Michael T. Mullen, Craig S. Anderson
Summary: Blood pressure is the most important modifiable risk factor for intracerebral hemorrhage. Early use of medication to achieve blood pressure control is beneficial for acute ICH recovery. Long-term use of oral antihypertensive drugs can achieve lower blood pressure goals. Sustained reduction in blood pressure is more important than the choice of antihypertensive agents.
Review
Veterinary Sciences
Kelly Hall, Kenneth Drobatz
Summary: Resuscitation of acutely hemorrhaging small animal patients, such as dogs and cats, should prioritize hemorrhage control and judicious crystalloid administration followed by early consideration for blood component therapy to minimize blood loss, ameliorate coagulopathy, restore oxygen delivery, and correct changes in the glycocalyx.
FRONTIERS IN VETERINARY SCIENCE
(2021)
Article
Clinical Neurology
Marcin Wiacek, Maciej Szymanski, Klaudia Walewska, Halina Bartosik-Psujek
Summary: This study aimed to evaluate the association of periprocedural blood pressure changes with symptomatic intracranial hemorrhage (sICH) and malignant brain edema (MBE) in patients undergoing endovascular treatment (EVT) for anterior circulation ischemic stroke. The results showed that a decrease in mean arterial blood pressure (MAP) during the procedure was associated with a higher risk of MBE occurrence, and a decrease in MAP over 40% was associated with a higher incidence of both MBE and sICH. Additionally, post-treatment elevation of systolic blood pressure (SBP) and MAP increased the risk of sICH.
FRONTIERS IN NEUROLOGY
(2022)
Article
Clinical Neurology
Ronda Lun, Vignan Yogendrakumar, Greg Walker, Michel Shamy, Robert Fahed, Adnan Qureshi, Dar Dowlatshahi
Summary: The study validates revised definitions of hematoma expansion incorporating intraventricular hemorrhage expansion for predicting poor outcome, outperforming conventional definitions even after accounting for care limitations.
INTERNATIONAL JOURNAL OF STROKE
(2021)
Article
Clinical Neurology
Xia Wang, Gian Luca Di Tanna, Tom J. Moullaali, Renee' H. Martin, Virginia B. Shipes, Thompson G. Robinson, John Chalmers, Jose Suarez, Adnan Qureshi, Yuko Y. Palesch, Craig S. Anderson
Summary: This study found that moderate rapid reductions in systolic blood pressure (SBP) in patients with acute intracerebral hemorrhage (ICH) are associated with improved functional outcomes, but large SBP reductions within 1 hour (e.g. from > 200 to target < 140 mmHg) are associated with a reduction or reversal of such benefits.
INTERNATIONAL JOURNAL OF STROKE
(2022)
Article
Cardiac & Cardiovascular Systems
Jong-Ho Park, Juneyoung Lee, Sun U. Kwon, Hyuk Sung Kwon, Min Hwan Lee, Dong-Wha Kang
Summary: The association between pulse pressure (PP) and recurrent stroke in ischemic stroke patients with cerebral microbleeds or intracerebral hemorrhage remains uncertain. This study found that long-term elevated PP and higher systolic blood pressure confer a greater risk of subsequent hemorrhagic stroke among stroke patients with cerebral microbleeds or intracerebral hemorrhage.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2022)
Article
Clinical Neurology
Kristin Tveitan Larsen, Maiken Nordahl Selseth, Silje Holt Jahr, Vigdis Hillestad, Nojoud Koubaa, Else Charlotte Sandset, Ole Morten Ronning, Espen Saxhaug Kristoffersen
Summary: This study investigated the relationship between prehospital blood pressure (BP) and clinical and radiological outcomes in acute intracerebral hemorrhage patients. The results showed that elevated prehospital BP parameters were associated with in-hospital death and hematoma expansion. Changes in prehospital BP were not consistently associated with outcome. A possible U-shaped association between prehospital BP and in-hospital death needs further investigation.
Article
Medicine, General & Internal
B. Neal, Y. Wu, X. Feng, R. Zhang, Y. Zhang, J. Shi, J. Zhang, M. Tian, L. Huang, Z. Li, Y. Yu, Y. Zhao, B. Zhou, J. Sun, Y. Liu, X. Yin, Z. Hao, J. Yu, K. -C. Li, X. Zhang, P. Duan, F. Wang, B. Ma, W. Shi, G. L. Di Tanna, S. Stepien, S. Shan, S. -A. Pearson, N. Li, L. L. Yan, D. Labarthe, P. Elliott
Summary: The study found that among individuals with a history of stroke or aged 60 or older with high blood pressure, using a salt substitute can reduce the rates of stroke, major cardiovascular events, and death.
NEW ENGLAND JOURNAL OF MEDICINE
(2021)
Article
Clinical Neurology
Juan Pablo Castello, Marco Pasi, Jessica R. Abramson, Axana Rodriguez-Torres, Sandro Marini, Stacie Demel, Lee Gilkerson, Patryk Kubiszewski, Andreas Charidimou, Christina Kourkoulis, Zora Dipucchio, Kristin Schwab, M. Edip Gurol, Anand Viswanathan, Christopher D. Anderson, Carl D. Langefeld, Matthew L. Flaherty, Amytis Towfighi, Steven M. Greenberg, Daniel Woo, Jonathan Rosand, Alessandro Biffi
Summary: Analysis of data from 922 intracerebral hemorrhage (ICH) survivors revealed that minority survivors had higher global CSVD and HTNA burden, leading to increased risk of ICH recurrence in HTNA-related and mixed-etiology ICH cases. These findings suggest significant differences in CSVD subtypes and severity among White and minority survivors, impacting known disparities in ICH recurrence risk. Future studies should consider detailed MRI-based assessments of CSVD subtypes and severity, as well as explore social determinants of health in understanding racial/ethnic disparities in ICH outcomes.
Article
Critical Care Medicine
Natalie J. Koons, Betty Nguyen, Mithun R. Suresh, Carmen Hinojosa-Laborde, Victor A. Convertino
Article
Critical Care Medicine
Victor A. Convertino, Mallory R. Wampler, Michael Johnson, Abdul Alarhayem, Tuan D. Le, Susannah Nicholson, John G. Myers, Kevin K. Chung, Katie R. Struck, Camaren Cuenca, Brian J. Eastridge
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
(2020)
Article
Critical Care Medicine
Avi Benov, Anat Brand, Tal Rozenblat, Ben Antebi, Anat Ben-Ari, Rotem Amir-Keret, Roy Nadler, Jacob Chen, Kevin K. Chung, Victor A. Convertino, Haim Paran
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
(2020)
Article
Critical Care Medicine
Natalie J. Koons, Gregory A. Owens, Donald L. Parsons, Steven G. Schauer, Jerome L. Buller, Victor A. Convertino
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
(2020)
Article
Critical Care Medicine
Taylor E. Schlotman, Mithun R. Suresh, Natalie J. Koons, Jeffrey T. Howard, Alicia M. Schiller, Sylvain Cardin, Victor A. Convertino
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
(2020)
Article
Multidisciplinary Sciences
Morten Zaar, Maryanne C. Herzig, Chriselda G. Fedyk, Robbie K. Montgomery, Nicolas Prat, Bijaya K. Parida, Carmen Hinojosa-Laborde, Gary W. Muniz, Robert E. Shade, Cassondra Bauer, Wilfred Delacruz, James A. Bynum, Victor A. Convertino, Andrew P. Cap, Heather F. Pidcoke, Nandu Goswami, Nandu Goswami, Nandu Goswami
Article
Hematology
Victor A. Convertino, Natalie J. Koons
Article
Hematology
Taylor E. Schlotman, Kevin S. Akers, Sylvain Cardin, Michael J. Morris, Tuan Le, Victor A. Convertino
Article
Medicine, General & Internal
Brandon M. Carius, Jason F. Naylor, Michael D. April, Andrew D. Fisher, Ian L. Hudson, Peter J. Stednick, Joseph K. Maddry, Erik K. Weitzel, Victor A. Convertino, Steve G. Schauer
Summary: The study focuses on the challenges of hemodynamic monitoring in combat casualties and proposes improvements. The investigation found that challenges in obtaining vital signs were mainly related to training and equipment, suggesting the need for better casualty monitoring systems, especially for critically injured casualties.
Article
Medicine, General & Internal
Steven G. Schauer, Jason F. Naylor, Gregory Dion, Michael D. April, Kevin K. Chung, Victor A. Convertino
Summary: The study found that for combat casualties receiving airway management, airway interventions did not significantly affect survival rates, supporting the role of airway interventions when indicated.
Meeting Abstract
Biochemistry & Molecular Biology
Victor A. Convertino
Review
Health Care Sciences & Services
Guy Avital, Eric J. Snider, David Berard, Saul J. Vega, Sofia I. Hernandez Torres, Victor A. Convertino, Jose Salinas, Emily N. Boice
Summary: Physiological closed-loop controlled systems play an important role in clinical practice, providing accurate and targeted care while reducing the workload of healthcare professionals. These systems offer standardized care management and have advantages in fluid management and administration, particularly in conditions that require precise care. Design and maturity level of controllers vary, but they have been tested and implemented in different areas, including peri-operative care, trauma, and acute burn care.
JOURNAL OF PERSONALIZED MEDICINE
(2022)
Article
Biotechnology & Applied Microbiology
Carlos N. Bedolla, Jose M. Gonzalez, Saul J. Vega, Victor A. Convertino, Eric J. Snider
Summary: Accurately tracking vital signs is crucial for triaging patients and providing timely treatment. Compensatory mechanisms can often obscure the patient's condition, making it difficult to assess the severity of injuries. Compensatory reserve measurement (CRM) is a triaging tool derived from an arterial waveform that allows for early detection of hemorrhagic shock. In this study, classical machine-learning models driven by specific features extracted from the arterial waveform were used to estimate CRM, resulting in similar accuracy to deep-learning algorithms. This methodology has the potential to improve trauma patient triage and enhance military and emergency medicine.
BIOENGINEERING-BASEL
(2023)
Article
Biotechnology & Applied Microbiology
Victor A. Convertino, Eric J. Snider, Sofia I. Hernandez-Torres, James P. Collier, Samantha K. Eaton, David R. Holmes III, Clifton R. Haider, Jose Salinas
Summary: This study aims to systematically evaluate the lower body negative pressure (LBNP) as a credible tool for studying human hemorrhage physiology. The evaluation based on verification and validation demonstrates the credibility, repeatability, and validity of LBNP compared to actual blood loss. The LBNP tool can be used for testing and developing advanced monitoring algorithms and evaluating wearable sensors, with the goal of improving clinical outcomes in emergency medical settings.
BIOENGINEERING-BASEL
(2023)
Review
Chemistry, Analytical
Victor A. Convertino, Steven G. Schauer, Erik K. Weitzel, Sylvain Cardin, Mark E. Stackle, Michael J. Talley, Michael N. Sawka, Omer T. Inan