Blood pressure and outcome post mechanical thrombectomy

Abstract

Data on the blood pressure (BP) following mechanical thrombectomy (MT) is limited. In this study, we aimed to evaluate the correlation between BP and functional outcome following MT. We included patients who received MT between 6/12014 and 2/2017 at our institution. BP data included systolic, diastolic, and mean arterial BP readings recorded on an hourly interval for 24 h post-procedure. Functional outcome was assessed using 90-day modified Rankin Scale (mRS). Good outcome was defined as mRS ≤ 2, and poor outcome as mRS 3-6. A total of 298 patients were included. Mean age was 66.8 ± 15.2 years; 51% of patients were female, and mean NIHSS was 15.4 ± 7.7. Average systolic blood pressure (SBP) was 121 ± 11.5 mm Hg in the good outcome group and 125 ± 12.5 mm Hg in the poor outcome; P < 0.001. Maximum SBP was 147.9 ± 20.5 mm Hg and 152.5 ± 18.3 mm Hg in the good and poor outcome group respectively, P < 0.05. On multivariate analysis, higher average SBP was associated with a lower chance of good outcome (Odds ratio 0.97; 95% Confidence interval 0.94-0.998; P 0.026). Patients with average SBP of <120 mm Hg in 24-hour post MT had a better 90-day outcome and a lower mortality rate when compared to patients with ≥120 mm Hg (median mRS; 2 (IQR 3) vs 3 (IQR4); P < 0.001, mortality (12.1% vs 25.9%; P < 0.01)). In conclusion, higher SBP in the acute phase post-MT was associated with a worse functional outcome. Prospective studies are urgently needed to determine the optimal BP goal post MT.

Keywords: Blood pressure; Hemorrhage; Stroke; Thrombectomy.