Restoring penumbral perfusion is the key therapeutic target in patients with acute ischemic stroke. In cases of insufficient or unsuccessful vessel recanalization, maintaining normal to higher mean arterial pressure (MAP) is an accepted goal. MAP is expected to improve cerebral perfusion (CP), as constant cerebral blood flow (CBF) is maintained over a wide range of MAP due to vessel autoregulation. This study assessed to relationship between CP and CO.

Subjects were ten consecutive inpatients with a large ischemic stroke in the middle cerebral artery (MCA) territory. Symptom severity was assessed using the the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) on admission and at discharge. Following hemodynamic baseline measurements, all patients were monitored with transcranial color-coded duplex sonography (TCCD) and transcranial perfusion sonography (TPS). Cerebral perfusion was assessed by transcranial color-coded duplex and transcranial perfusion sonography. Time-to-peak (TTP) values of defined regions of interest (ROI), as well as hemodynamic parameters, were assessed, including MAP and cardiac index (CI).

The analyses of CI and MAP levels, TTP and MCA velocity revealed highly significant inverse correlations of CI and TTP in the affected and unaffected basal ganglia (P<0.001) and (P<0.0001), respectively.

This study of patients with acute ischemic stroke suggests that the cardiac output may be more relevant than mean arterial pressure as a guide while optimizing cerebral penumbral perfusion.