The role of phenylephrine in patients with small deep subcortical infarct and progressive weakness

Abstract

Background and purpose: Although progression of small deep subcortical infarct (PSDI) comprises 12% to 36% of all small deep subcortical infarcts, the therapy for progression is not clear. This study investigated whether induced-hypertension therapy using phenylephrine is a useful therapy for PSDI. Methods: A group of 2427 consecutive patients, diagnosed with stroke at a tertiary hospital over a period of 4 years was reviewed retrospectively. We analyzed patients with small deep subcortical infarct using clinical, laboratory, and pulse wave velocity (PWV). PSDI is defined as one or more increase in the motor score according to the NIHSS. Good outcome was designated as a modified Rankin scale of 0 to 2 at discharge. Results: Among all 662 patients who had a small deep subcortical infarct, 66 patients experienced motor progression (9.97%). The induced-hypertension therapy group (n = 25) received phenylephrine, and the conventional group (n = 41) received anticoagulation therapy such as heparin, volume expansion, or both. Although there were no significant differences in baseline clinical and laboratory findings, the PSDI group showed a significantly more frequent decrease in blood pressure at progression (P < 0.0001) and higher PWV (P = 0.001). The phenylephrine group (vs the conventional group) had a lower NIHSS score (P = 0.036) and good outcome at discharge (P = 0.004). In multiple regression analysis, PWV (OR, 1.004 per 1-cm/s increase; 95% CI, 1.001-1.008; P = 0.018) was an independent predictor of good outcome in the phenylephrine group. A side effect of phenylephrine treatment was dysuria (n = 1). Conclusions: The present study suggests that vascular stiffness can be not only a predictor for PSDI but also a predictor of motor improvement after induced-hypertension therapy using phenylephrine in lacunar stroke. (C) 2017 Elsevier B.V. All rights reserved.