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Multicenter Study
. 2020 Oct;12(10):932-936.
doi: 10.1136/neurintsurg-2019-015561. Epub 2019 Dec 5.

Blood pressure reduction and outcome after endovascular therapy with successful reperfusion: a multicenter study

Mohammad Anadani  1 , Adam S Arthur  2 , Ali Alawieh  3 , Yser Orabi  3 , Andrei Alexandrov  4 , Nitin Goyal  4 , Marios-Nikos Psychogios  5 , Ilko Maier  6 , Joon-Tae Kim  7 , Saleh G Keyrouz  8 , Adam de Havenon  9 , Nils H Petersen  10 , Abhi Pandhi  11 , Christa B Swisher  12 , Ovais Inamullah  12 , Jan Liman  13 , Sreeja Kodali  10 , James A Giles  8 , Michelle Allen  8 , Stacey Q Wolfe  14 , Georgios Tsivgoulis  15 , Bradley A Cagle  14 , Chesney S Oravec  14 , Benjamin Gory  16 , Pierre De Marini  16 , Peter Kan  17 , Shareena Rahman  12 , Sébastien Richard  18 , Fábio A Nascimento  19 , Alejandro Spiotta  1
Affiliations
Multicenter Study

Blood pressure reduction and outcome after endovascular therapy with successful reperfusion: a multicenter study

Mohammad Anadani et al. J Neurointerv Surg. 2020 Oct.

Abstract

Background: Elevated systolic blood pressure (SBP) after mechanical thrombectomy (MT) correlates with worse outcome. However, the association between SBP reduction (SBPr) and outcome after successful reperfusion with MT is not well established.

Objective: To investigate the association between SBPr in the first 24 hours after successful reperfusion and the functional and safety outcomes of MT.

Methods: A multicenter retrospective study, which included 10 comprehensive stroke centers, was carried out. Patients with acute ischemic stroke and anterior circulation large vessel occlusions who achieved successful reperfusion via MT were included. SBPr was calculated using the formula 100×([admission SBP-mean SBP]/admission SBP). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3-6 at 90 days. Safety endpoints included symptomatic intracerebral hemorrhage, mortality, and requirement for hemicraniectomy during admission. A generalized mixed linear model was used to study the association between SBPr and outcomes.

Results: A total of 1361 patients were included in the final analysis. SBPr as a continuous variable was inversely associated with poor outcome (OR=0.97; 95% CI 0.95 to 0.98; p<0.001) but not with the safety outcomes. Subanalysis based on reperfusion status showed that SBPr was associated with lower odds of poor outcome only in patients with complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI 3)) but not in patients with incomplete reperfusion (mTICI 2b). When SBPr was divided into categories (<1%, 1%-10%, 11%-20%, >20%), the rate of poor outcome was highest in the first group.

Conclusion: SBPr in the first 24 hours after successful reperfusion was inversely associated with poor outcome. No association between SBPr and safety outcome was found.

Keywords: blood pressure; stroke; thrombectomy.

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Conflict of interest statement

Competing interests: AS has honoris for consulting for Penumbra and Cerenovus. M-NP received honoraria; modest; received speakers’ honoraria from Siemens Healthineers.SQW reports U24NS107235- 01 NIH/NINDS StrokeNET Site Co-I. The other authors report no conflicts.

Figures

Figure 1
Figure 1
Histogram of systolic blood pressure reduction.
Figure 2
Figure 2
(A) Distribution of poor outcome across 4 SBPr categories (<1%, 1%–10%, 11%–20%, and >20%); (B) OR and 95% CI of the association between SBPr categories and poor outcome (<1% category was used as a reference). SBPr, systolic blood pressure reduction.
See this image and copyright information in PMC

References

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