Blood pressure levels post mechanical thrombectomy and outcomes in large vessel occlusion strokes

Goyal, Nitin; Tsivgoulis, Georgios; Pandhi, Abhi; Chang, Jason J.; Dillard, Kira; Ishfaq, Muhammad F; Nearing, Katherine; Choudhri, Asim F.; Hoit, Daniel; Alexandrov, Anne W.; Arthur, Adam S; Elijovich, Lucas

doi:10.1212/wnl.0000000000004184

Cited by 159 publications

(172 citation statements)

References 31 publications

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“…We included patients with AIS with CT angiography (CTA)-confirmed large vessel occlusions who presented within 6 hours of symptom onset and underwent MT. For patients presenting between 6 and 12 hours from symptom onset, additional imaging selection criteria were used such as Alberta Stroke Program Early CT Score (ASPECTS) ≥6 on CT head and/or good collaterals on CTA 15. CT and CTA were performed on a 64-slice scanner.…”

Section: Methodsmentioning

confidence: 99%

“…Successful recanalization at the end of the endovascular procedure was defined by modified Thrombolysis in Cerebral Infarction (mTICI) grades 2b or 3, which were obtained from the reports of endovascular specialists (LE, AA, and DH) 15. Functional outcome was evaluated at 3 months using the modified Rankin Scale (mRS) scores by certified vascular neurologists.…”

Section: Methodsmentioning

confidence: 99%

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Antiplatelet pretreatment and outcomes following mechanical thrombectomy for emergent large vessel occlusion strokes

Pandhi

Tsivgoulis

Krishnan

et al. 2017

J NeuroIntervent Surg

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Antiplatelet pretreatment and outcomes following mechanical thrombectomy for emergent large vessel occlusion strokes

Pandhi

Tsivgoulis

Krishnan

et al. 2017

J NeuroIntervent Surg

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“…The baseline characteristics of the patients are shown in Table 1. The median baseline NIHSS score was 12 (interquartile range 9-15), and the pretreatment DWI-ASPECTS was 8 (6)(7)(8)(9). Good outcomes at 3 months (mRS score 0-2) were achieved in 149 (39.4%) patients, SICH occurred in 60 (15.9%) patients and mortality was recorded in 32 (8.5%) patients.…”

Section: General Characteristicsmentioning

confidence: 99%

Associations of various blood pressure parameters with functional outcomes after endovascular thrombectomy in acute ischaemic stroke

Cho

Kim²,

Lee

et al. 2019

Euro J of Neurology

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Background and purpose High blood pressure (BP) at presentation is associated with poor outcomes in acute ischaemic stroke, but serial BP measurements may better delineate the clinical implications of BP. The aim was to investigate the association between various BP parameters and functional outcomes in acute ischaemic stroke patients treated with endovascular thrombectomy (EVT). Methods This study reports a retrospective analysis of a prospective registry of a comprehensive stroke centre. Patients treated with EVT due to large vessel occlusion in the anterior circulation were enrolled. BP was measured hourly during the first 24 h after admission. Associations of various BP parameters, including BP variability, with functional outcomes at 3 months, including good outcomes (modified Rankin Scale score of 0–2), were analysed. Results Of the 378 enrolled patients (mean age 70 ± 11 years, male 54.2%), 313 (82.8%) achieved successful reperfusion after EVT, and 149 (39.4%) had good outcomes at 3 months. Higher mean systolic BP [each 10 mmHg increase, odds ratio 0.82 (0.69–0.97)] and higher systolic successive variation (SV) [each 10% increase, odds ratio 0.37 (0.18–0.76)] were associated with a reduced likelihood of achieving good outcomes. In addition, reperfusion status after EVT moderated the influence of higher systolic SV on good outcomes (Pint = 0.05). Conclusion The results showed that a higher mean systolic BP and systolic SV during the first 24 h of EVT reduced the likelihood of good outcomes at 3 months. The effects of these parameters on outcomes are more substantial amongst patients with successful reperfusion after EVT, suggesting that different BP control strategies should be employed according to reperfusion status.

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“…28 To date, one observational study on BP levels after mechanical thrombectomy was evaluated in consecutive patients with large-vessel occlusion. 29 A 10 mm Hg increment maximum SBP in the first 24 hours after mechanical thrombectomy was associated with a higher odds of 3-month mortality and functional dependence. In addition, BP lower than 160/90 mm Hg was independently associated with a lower 3-month mortality in comparison with permissive hypertension (lower than 220/110 mm Hg or lower than 180/105 mm Hg when pretreated with intravenous thrombolysis).…”

Section: Ischemic Stroke Patients Treated With Mechanical Thrombectomymentioning

confidence: 88%

Acute Blood Pressure Management in Neurocritically Ill Patients

Levasseur-Franklin

Makii

2019

Pharmacotherapy

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Optimal blood pressure (BP) management is controversial in neurocritically ill patients due to conflicting concerns of worsening ischemia with decreased BP versus cerebral edema and increased intracranial pressure with elevated BP. In addition, high‐quality evidence is lacking regarding optimal BP goals in patients with most of these conditions. This review summarizes guideline recommendations and examines the literature for BP management in patients with ischemic stroke, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, traumatic brain injury, and spinal cord injury.

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Blood pressure levels post mechanical thrombectomy and outcomes in large vessel occlusion strokes

Abstract: High maximum SBP levels following MT are independently associated with increased likelihood of 3-month mortality and functional dependence in LVO patients. Moderate BP control is also related to lower odds of 3-month mortality in comparison to permissive hypertension.

Cited by 159 publications

References 31 publications

Antiplatelet pretreatment and outcomes following mechanical thrombectomy for emergent large vessel occlusion strokes

Antiplatelet pretreatment and outcomes following mechanical thrombectomy for emergent large vessel occlusion strokes

Associations of various blood pressure parameters with functional outcomes after endovascular thrombectomy in acute ischaemic stroke

Acute Blood Pressure Management in Neurocritically Ill Patients

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