Association between systolic blood pressure parameters and unexplained early neurological deterioration (UnND) in acute ischemic stroke patients treated with mechanical thrombectomy

Abstract

Background: Neurological deterioration (ND) after mechanical thrombectomy (MT) of acute ischemic stroke (AIS) in anterior circulation is an important complication associated with a poor outcome. Moreover, evident causes of ND may remain unexplained (UnND). Objective: We sought to evaluate the association of the systolic blood pressure (SBP) parameters before MT, during MT, and during a 24-h period after MT with UnND. Methods: We analyzed 382 MT-treated AIS patients in two stroke centers from 2017 to 2019. The patients with unsuccessful recanalization and/or with symptomatic intracerebral hemorrhage after MT were excluded. Multivariate logistic regression analysis was used to identify the SBP parameters that predict UnND. Results: There were 5.9% patients with UnND within 24 h after MT among patients with successful recanalization what comprises 4.9% of all patients who had undergone MT. SBP > 180 mmHg on admission (odds ratio (OR): 4, 95% confidence interval (CI): 1.6–10, p = 0.004) and a drop of SBP below100 mmHg during MT (OR: 4.7, 95% CI: 1.3–17, p = 0.019) were associated with UnND occurrence within 7 days without a significant association with UnND within 24 h. UnND within 7 days was predicted by the episodes of SBP exceeding the level of SBP observed before the groin puncture and occurring over the first 2 h following recanalization (OR: 5, 95% CI: 1.3–19, p = 0.021), an increase of SBP of more than 20% within 2–24 h after MT (OR: 3.4, 95% CI: 1.1–10, p = 0.035), and a drop of SBP below 100 mmHg after MT (OR: 3.2, 95% CI: 1.1–9, p = 0.039). Conclusion: The association between the SBP parameters and UnND depends on the treatment period and the time of UnND occurrence. The J/U resembling relationship between SBP and UnEND was established during a 24-h period after MT.

CNS-LAND score: predicting early neurological deterioration after intravenous thrombolysis based on systemic responses and injury

“…Elevated systolic blood pressure may indicate a disorder of vascular autoregulation ( 3 , 32–34 ). High systolic blood pressure can cause vasodilation of the microvessels and hyperperfusion in the infarct area, leading to cerebral edema and blood–brain barrier damage ( 35 , 36 ). Currently, the management of blood pressure after acute ischemic attack is controversial.…”

Intensive Blood Pressure Control After Mechanical Thrombectomy for Acute Ischemic Stroke

“…The question is why some studies demonstrate a U -shaped cure while others demonstrate a linear relationship. 9,10 Some studies simply might allow patients to reach extreme values at which a U -shaped curve would emerge or employ statistical methods capable of its recognition. It is also possible that key differences in patient populations play a role.…”