Title: Cerebral Haemodynamic in Stroke Thrombolysis (CHiST) Study Background and aims: Approximately 50% of acute ischaemic stroke (AIS) patients receiving intravenous thrombolysis (IV rtPA) have successful recanalization of the occluded intracranial arteries. Understanding how cerebral autoregulation (CA), and other haemodynamic parameters, are affected in AIS patients, particularly during IV rtPA, may provide information about their association with reperfusion injury or improvements in outcome. Methods: Cerebral blood velocity (CBV, Transcranial Doppler), beat-to-beat blood pressure (BP, Finometer) and end-tidal carbon dioxide (ETCO2, capnography) were recorded in eleven participants (5 female, age 68±11 years) during and immediately after IV rtPA and at 3 further visits (123±38 mins; 23.9±2.6 hrs; 18.1±7 days and 89.6±4.2 days of stroke symptom onset), respectively. Results: BP (p=0.03) and heart rate (p<0.005) reduction were observed across four visits. ETCO2 demonstrated a significant increment post 24 hours of stroke symptoms onset (p=0.034). CBV did not demonstrate any significant differences in overall temporal patterns across four visits, nor between hemispheric values. Affected hemisphere (AH) demonstrated a reduction in CA (ARI index) during IV rtPA (5.45±2.65 to 4.48±2.82) which increased immediately after completion. Three participants had impaired AH ARI (<4) at first visit, all of them have improved AH ARI (>4) and Modified Rankin Scale ≤ 1 at visit 3. No differences were observed between both hemispheres ARI values across all visits. Conclusion: Worsening dynamic CA during IV rtPA suggests closer BP monitoring during this critical stage is needed to prevent further ischaemia or hyperperfusion. Future investigations will look at the application of such knowledge within personalised AIS care to best facilitate recovery. Trial Registration Number: NCT 02928926
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