Blood Pressure Trajectories and Outcomes After Endovascular Thrombectomy for Acute Ischemic Stroke

Abstract

Background: Data on systolic blood pressure (SBP) trajectories in the first 24 hours after endovascular thrombectomy (EVT) in acute ischemic stroke are limited. We sought to identify these trajectories and their relationship to outcomes.

Methods: We combined individual-level data from 5 studies of patients with acute ischemic stroke who underwent EVT and had individual blood pressure values after the end of the procedure. We used group-based trajectory analysis to identify the number and shape of SBP trajectories post-EVT. We used mixed effects regression models to identify associations between trajectory groups and outcomes adjusting for potential confounders and reported the respective adjusted odds ratios (aORs) and common odds ratios.

Results: There were 2640 total patients with acute ischemic stroke included in the analysis. The most parsimonious model identified 4 distinct SBP trajectories, that is, general directional patterns after repeated SBP measurements: high, moderate-high, moderate, and low. Patients in the higher blood pressure trajectory groups were older, had a higher prevalence of vascular risk factors, presented with more severe stroke syndromes, and were less likely to achieve successful recanalization after the EVT. In the adjusted analyses, only patients in the high-SBP trajectory were found to have significantly higher odds of early neurological deterioration (aOR, 1.84 [95% CI, 1.20-2.82]), intracranial hemorrhage (aOR, 1.84 [95% CI, 1.31-2.59]), mortality (aOR, 1.75 [95% CI, 1.21-2.53), death or disability (aOR, 1.63 [95% CI, 1.15-2.31]), and worse functional outcomes (adjusted common odds ratio,1.92 [95% CI, 1.47-2.50]).

Conclusions: Patients follow distinct SBP trajectories in the first 24 hours after an EVT. Persistently elevated SBP after the procedure is associated with unfavorable short-term and long-term outcomes.

Keywords: blood pressure; hypertension; ischemic stroke; stroke; thrombectomy.

Figure 1.

Systolic blood pressure trajectories in the first 24 hours after endovascular stroke thrombectomy

Figure 2.

Systolic blood pressure trajectories in the first 24 hours after endovascular stroke thrombectomy in patients with (A) successful reperfusion (TICI score 2b or higher), (B) unsuccessful reperfusion (TICI score 0-2a)

Figure 3.

Distribution of modified Rankin Scale scores at 3-months stratified by distinct systolic blood pressure trajectories in the first 24 hours after endovascular stroke thrombectomy.