Association of Blood Pressure With Outcomes in Acute Stroke Thrombectomy

Abstract

Limited data exist evaluating the effect of blood pressure (BP) on clinical outcomes among patients with acute ischemic stroke with large vessel occlusion treated with mechanical thrombectomy (MT). We sought to evaluate the association of BP levels on clinical outcomes among patients with acute ischemic stroke with large vessel occlusion treated with MT. Studies were identified that reported the association of systolic BP (SBP) or diastolic BP levels before, during, or after MT on the outcomes of patients with acute ischemic stroke treated with MT. Unadjusted and adjusted analyses of studies reporting odds ratios (OR adj ) per 10 mm Hg BP increment were performed. Our analysis included 25 studies comprising 6474 patients. Higher pre-MT mean SBP ( P =0.008) and post-MT maximum SBP ( P =0.009) levels were observed in patients who died within 3 months. Patients with 3-month functional independence were noted to have lower pre-MT ( P <0.001) and post-MT maximum SBP levels ( P <0.001). In adjusted analyses, increasing post-MT maximum SBP and diastolic BP levels were associated with 3-month mortality (OR adj , 1.19 [95% CI,1.00–1.43]; I 2 =78%, P value for Cochran Q test: 0.001) and symptomatic intracranial hemorrhage (OR adj , 1.65 [95% CI, 1.11–2.44]; I 2 =0%, P value for Cochran Q test: 0.80), respectively. Increasing pre- and post-MT mean SBP levels were associated with lower odds of 3-month functional independence (OR adj , 0.86 [95% CI, 0.77–0.96]; I 2 =18%, P value for Cochran Q test: 0.30) and (OR adj , 0.80 [95% CI, 0.72–0.89]; I 2 =0%, P value for Cochran Q test: 0.51), respectively. In conclusion, elevated BP levels before and after MT are associated with adverse outcomes among patients with acute ischemic stroke with large vessel occlusion.

Association of Blood Pressure at Successful Recanalization and Parenchymal Hemorrhage After Mechanical Thrombectomy With General Anesthesia

“…The current guidelines from the American Heart Association/American Stroke Association guidelines arbitrarily recommend blood pressure (BP) control of <180/105 mm Hg during and after MT. However, data regarding guidance for optimal BP management among patients treated with MT remain scarce ( 4 ). Theoretically, the target of BP control should be lower in patients following MT because of the high hemorrhagic transformation risk after clot removal ( 5 ).…”

Impact of Blood Pressure After Successful Endovascular Therapy for Anterior Acute Ischemic Stroke: A Systematic Review

“…Given the significant heterogeneity among the different hemodynamic parameters used, no meta-analysis of association was performed. Although a recent meta-analysis concerning BP management before, during and after AIS was recently published (26), this very analysis appropriately excluded overlapping data [i.e., studies involving the same population, which was the case in the present analysis for three studies from the same author (6,13,30)] and did not focus on successfully reperfused patients only. The present analysis therefore provides updated additional data and seems to point toward similar results, regarding the impact of BP values post-EVT and the need of quality RCT regarding this issue.…”

“…Numerous observational studies have recently outlined the association between higher post-reperfusion BP values and sICH or worse functional outcomes, notably according to the reperfusion status (6-9, 11, 13-25). A recent systematic review and meta-analysis focusing on mean systolic BP (SBP) and diastolic BP (DBP) suggested that increased BP after EVT was associated with sICH and 3-month functional dependence (26). Still, many questions remain unanswered such as the specific BP target to achieve, the best pharmacological approach according to the reperfusion status and the impact of BP variability after EVT.…”

Hemodynamics and Hemorrhagic Transformation After Endovascular Therapy for Ischemic Stroke

“…Despite the efficacy of EVT, many patients with LVO stroke still suffer morbidity, mortality, and functional dependence in longitudinal studies ( 7 , 18 ). Observational studies, including a recent meta-analysis, have shown higher rates of HT, worse outcomes, and increased mortality in patients with higher peak SBP values or hemodynamic variability in the first 24 hours after EVT ( 15 , 19 – 21 ). However, it remains unclear if post-procedural hypertension is simply an epiphenomenon, or if it reflects a valid therapeutic target.…”