Prolonged Duration of Blood Pressure Drops During General Anesthesia Is Associated With Worse Outcomes After Mechanical Thrombectomy

Abstract

Background and Purpose: Optimal periprocedural management of blood pressure during mechanical thrombectomy (MT) remains controversial. This study aimed to investigate the relationship between the duration of blood pressure drops during general anesthesia and the outcomes in large vessel occlusion (LVO) patients treated with MT. Methods: We retrospectively reviewed our prospectively collected data for LVO patients treated with MT between January 2018 and July 2020. Intraprocedural mean arterial pressure (MAP) was recorded every 5 min throughout the procedure. Baseline MAP minus each MAP value recorded during general anesthesia was defined ΔMAP. Cumulated time (in min) and longest continuous episode (in min) with ΔMAP more than 10, 15, 20, 25, and 30 mmHg were calculated, respectively. Poor outcome was defined as 90-day modified Rankin score (mRS) 3-6. Associations between cumulated time of different ΔMAP thresholds and poor outcome were determined using binary logistic regression models. Results: A total of 131 patients were finally included in the study. After controlling for age, atrial fibrillation, baseline NIHSS, baseline ASPECTS, procedure duration of MT, and times of retrieval attempts, the results indicated that cumulated time of MAP drop more than 10 mmHg (OR 1.013; 95% CI 1.004-1.023; P = 0.007) and 15 mmHg (OR 1.011; 95% CI 1.002-1.020; P = 0.017) were independently associated with poor outcomes. Conclusion: Prolonged episodes of intraprocedural MAP lowering were more likely to have poor outcomes in LVO patients following MT with general anesthesia, which might be helpful in guiding intraprocedural hemodynamic management of patients under general anesthesia.

Keywords: blood pressure; general anesthesia; large artery occlusion; mechanical thrombectomy; outcome.

Figure 1

Spline plots of cumulated time (minutes) with MAP drop more than 10 or 15 mmHg and adjusted odds ratio (OR).

Figure 2

Association of cumulated time (minutes) with functional outcomes at 90 days. Cumulated times with MAP drop more than 10 mmHg or 15 mmHg were plotted per each modified Rankin Scale (mRS) score at 90 days. Bar graphs represent cumulated time with MAP drop for each mRS score category; Error bars indicate the 95% CI.