Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy

Mistry, Eva; Mehta, Tapan; Mistry, Akshitkumar M.; Arora, Niraj; Starosciak, Amy; Rosa, Felipe De Los Rios La; Siegler, James E.; Chitale, Rohan; Anadani, Mohammad; Yaghi, Shadi; Khatri, Pooja; Havenon, Adam de

doi:10.1161/strokeaha.119.027549

Cited by 91 publications

(144 citation statements)

References 37 publications

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“…Blood pressure management is a key challenge in acute ischemic stroke treatment, especially in patients who achieve successful reperfusion with endovascular therapy. Cumulative evidence supports a link between higher BP on admission or after MT and worse functional outcome 3–7. However, the effect of SBPr in the first 24 hours on outcome after successful reperfusion is not well understood.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertension is common among patients with stroke and especially those presenting with acute ischemic stroke owing to large vessel occlusions 1 2. Many studies investigating the relation between blood pressure (BP) and outcome after mechanical thrombectomy (MT) have reported a significant association between higher BP and poor outcome,3–7 a finding that is consistent with studies from before the thrombectomy era 8 9. However, the relationship between systolic BP reduction (SBPr) and outcome of MT has not been studied.…”

Section: Introductionmentioning

confidence: 97%

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Blood pressure reduction and outcome after endovascular therapy with successful reperfusion: a multicenter study

Anadani

Arthur

Alawieh

et al. 2019

J NeuroIntervent Surg

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BackgroundElevated systolic blood pressure (SBP) after mechanical thrombectomy (MT) correlates with worse outcome. However, the association between SBP reduction (SBPr) and outcome after successful reperfusion with MT is not well established.ObjectiveTo investigate the association between SBPr in the first 24 hours after successful reperfusion and the functional and safety outcomes of MT.MethodsA multicenter retrospective study, which included 10 comprehensive stroke centers, was carried out. Patients with acute ischemic stroke and anterior circulation large vessel occlusions who achieved successful reperfusion via MT were included. SBPr was calculated using the formula 100×([admission SBP−mean SBP]/admission SBP). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3–6 at 90 days. Safety endpoints included symptomatic intracerebral hemorrhage, mortality, and requirement for hemicraniectomy during admission. A generalized mixed linear model was used to study the association between SBPr and outcomes.ResultsA total of 1361 patients were included in the final analysis. SBPr as a continuous variable was inversely associated with poor outcome (OR=0.97; 95% CI 0.95 to 0.98; p<0.001) but not with the safety outcomes. Subanalysis based on reperfusion status showed that SBPr was associated with lower odds of poor outcome only in patients with complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI 3)) but not in patients with incomplete reperfusion (mTICI 2b). When SBPr was divided into categories (<1%, 1%–10%, 11%–20%, >20%), the rate of poor outcome was highest in the first group.ConclusionSBPr in the first 24 hours after successful reperfusion was inversely associated with poor outcome. No association between SBPr and safety outcome was found.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Blood pressure reduction and outcome after endovascular therapy with successful reperfusion: a multicenter study

Anadani

Arthur

Alawieh

et al. 2019

J NeuroIntervent Surg

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“…For example, incomplete recanalization may result in increased intracranial vascular resistance and subsequent blood pressure variability ( 47 ). Likewise, patients who present with less blood pressure variability experience better short-term ( 48 ) and long-term ( 49 ) functional outcomes. Blood pressure variability can be measured using several statistical formulas, including standard deviation (SD), coefficient of variation, successive variation (SV), and average real variation (ARV).…”

Section: Hemodynamics and Pathophysiology Of Lvo Strokesmentioning

confidence: 99%

“…Our group has demonstrated poor discharge outcomes among successfully recanalized patients who had sustained hypoperfusion for >12 hours, as well as those with higher blood pressure variability in the first 24 hours following MT ( 69 , 48 ). Similarly, in a post-hoc analysis of the BEST trial data, the patients with higher blood pressure variability within the first 24 hours had poor 90-day functional outcomes ( 49 ).…”

Section: Current Guidelinesmentioning

confidence: 99%

Blood Pressure Management Following Large Vessel Occlusion Strokes: A Narrative Review

Das¹,

John²,

Bokka³

et al. 2020

Balkan Med J

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Stroke is one of the leading causes of morbidity and mortality worldwide. Intravenous tissue plasminogen activator and mechanical thrombectomy comprise the two major treatments for acute ischemic stroke. Tissue plasminogen activator has been used for more than two decades and guidelines for hemodynamic management following tissue plasminogen activator administration are well established. However, mechanical thrombectomy is a relatively newer therapy and there is a paucity of evidence regarding hemodynamic management following large vessel occlusion strokes. The important tenets guiding the pathophysiology of large vessel occlusion strokes include understanding of cerebral autoregulation, collateral circulation, and blood pressure variability. In this narrative review, we discuss the current American Heart Association-American Stroke Association guidelines for the early management of acute ischemic stroke during different phases of the illness, encountered at different sections of a hospital including the emergency room, the neuro-interventional suite, and the intensive care unit. There is emerging evidence with regard to post-recanalization blood pressure management following large vessel occlusion strokes. Future research directions will include real-time blood pressure variability assessments, identifying the extent of impaired autoregulation, and providing guidelines related to range and personalized blood pressure trajectories for patients following large vessel occlusion strokes.

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“…Blood pressure variability (BPV) is one of the factors that related to prognosis of ischemic stroke. Several studies suggested that increased BPV was associated with poor neurologic outcome, [14][15][16] while the mechanism behind is not fully understood. Researches on hypertension suggested injured endothelium due to highly fluctuating abnormal blood flow related to vascular inflammation, 17,18 and meanwhile accumulating evidence suggested inflammation played a central role in all aspects of stroke including its initiation and progression.…”

Section: Introductionmentioning

confidence: 99%

<p>Associations of Interleukin 10, Matrix Metallopeptidase 9, and Legumain with Blood Pressure Variability and Neurologic Outcomes in Patients with Ischemic Stroke</p>

Rong¹,

He²,

Hua³

et al. 2020

IJGM

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Background Timely diagnosis and treatment are crucial to improve prognosis of ischemic stroke, making exploring factors associated with prognosis essential. Blood pressure variability (BPV) was reported to be associated with neurologic outcome, and basic researches on cardiovascular diseases found abnormal expression patterns of several factors including interleukin 10 (IL-10), matrix metallopeptidase 9 (MMP-9), and legumain which might be related to abnormal BPV but yet to prove in ischemic stroke. The study aimed to investigate whether IL-10, MMP-9, and legumain are associated with BPV and neurologic outcome of patients with ischemic stroke. Patients and Methods Newly diagnosed ischemic stroke patients admitted to the department of neurology, Shidong Hospital of Yangpu District in Shanghai between July 2017 and January 2019 were enrolled. IL-10, MMP-9, and legumain were detected and BPV was assessed within 72 hours after admission. All the patients were followed for neurologic outcomes at discharge and 6 months after admission based on the Modified Rankin Scale (MRS). Correlations of IL-10, MMP-9, and legumain with BPV were examined by Spearman correlation coefficient, and their associations with neurologic outcomes were evaluated by multivariable linear regression. Results A total of 349 patients with ischemic stroke were enrolled with an average age of 72.97±11.47 years. Compared with non-progressive ischemic stroke, patients with progressive ischemic stroke had significantly higher IL-10, MMP-9, and legumain on admission. MMP-9 was found to be positively correlated with BPV while no significant correlation was found for IL-10 and legumain with BPV. MMP-9 was associated with progressive ischemic stroke [β=0.23 (95% CI 0.11–0.35) per SD increase for MRS at discharge, and β=0.32 (95% CI 0.20–0.43) per SD increase for MRS at 6 months after admission]. Conclusion Increased MMP-9 was associated with increased BPV and progressive ischemic stroke for patients with ischemic stroke, which might partially explain the effect of BPV on neurologic outcomes.

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Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy

Cited by 91 publications

References 37 publications

Blood pressure reduction and outcome after endovascular therapy with successful reperfusion: a multicenter study

Blood pressure reduction and outcome after endovascular therapy with successful reperfusion: a multicenter study

Blood Pressure Management Following Large Vessel Occlusion Strokes: A Narrative Review

<p>Associations of Interleukin 10, Matrix Metallopeptidase 9, and Legumain with Blood Pressure Variability and Neurologic Outcomes in Patients with Ischemic Stroke</p>

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