Effect of blood pressure parameters on functional independence in patients with acute ischemic stroke in the first 6 hours after endovascular thrombectomy

Abstract

Background and purposeStudies have suggested that blood pressure (BP) levels after endovascular thrombectomy (EVT) are correlated with clinical outcomes. The aim of our study was to investigate the effect of BP in different time intervals within the first 24 hours after EVT on functional outcomes.MethodsData of patients who received EVT for acute ischemic stroke at two institutions were reviewed. After EVT, hourly BP data were collected and divided into four time intervals: 1–6 hours, 7–12 hours, 13–18 hours, and 19–24 hours. The mean, maximum, and standard deviation (SD) of BP were calculated and compared with the outcome of interest in patients with successful recanalization. The outcome of interest was functional independence, which was defined as a 3-month modified Rankin Scale score of ≤2.ResultsOf 224 patients with stroke who received EVT, 166 (74.1%) (mean age 70.2±13.1 years; 49.4% men) achieved successful recanalization and 82 (49.4%) exhibited functional independence. After adjustment for possible confounders, lower mean, maximum, and SD values of systolic and diastolic BP observed in the first 6 hours after EVT were independently associated with functional independence. Furthermore, the area under the receiver operating characteristic curve values observed for BP parameters for outcome prediction in the first 6 hours were the highest across the 24-hour period following EVT.ConclusionIn patients with stroke who achieved successful recanalization, the first 6 hours after EVT was the key period influencing the correlation between BP and functional outcome.

Systolic blood pressure variability following endovascular thrombectomy and clinical outcome in acute ischemic stroke: A meta‐analysis

“…Studies concluded the relationship between short‐term systolic BPV and poor clinical outcomes was influenced by recanalization status following EVT, as determined by the modified Thrombolysis in Cerebral Infarction (MTICI) scores. In five separate studies, the association was strongest for patients with successful recanalization (mTICI 2b or 3) 11‐14,17 . However, this is in contrast with both Anadani et al's 7 study, which found no difference in the association based on recanalization status, and the study by Bennett et al, 9 which showed the association was strongest in patients with poor recanalization (mTICI < 2b).…”

“…The majority of the patients had large vessel occlusion of the anterior circulation. NIHSS score at admission ranged from 12 11 to 19, 12 whereas the ASPECTS score at admission ranged from 6 9 to 9 7 . The onset of stroke symptoms to groin puncture time was mentioned in five studies 7,11‐14 and ranged from 154 min to 531 min.…”

“…NIHSS score at admission ranged from 12 11 to 19, 12 whereas the ASPECTS score at admission ranged from 6 9 to 9 7 . The onset of stroke symptoms to groin puncture time was mentioned in five studies 7,11‐14 and ranged from 154 min to 531 min. Groin puncture to recanalization time was mentioned in four studies 7,9,13,15 and ranged from 0.52 to 2.25 min (31–135 s).…”

“…Groin puncture to recanalization time was mentioned in four studies 7,9,13,15 and ranged from 0.52 to 2.25 min (31–135 s). The onset of stroke symptoms to recanalization time was mentioned in six studies 8,11,12,16‐18 and ranged from 216 to 432 min. Patients receiving thrombolysis before MT were least represented (26%) in the study by Zhang et al, 14 while the study by Shriki et al 16 had the highest percentage of patients receiving thrombolysis at 68%.…”

Impact of Early Blood Pressure Lowering in Patients Presenting with Acute Ischemic Stroke

“…This was particularly consistent in subjects with complete recanalization and no history of premorbid hypertension. Another retrospective study from Taiwan showed that the uncontrolled elevation of the blood pressure in the immediate first 6 h after a successful mechanical thrombectomy is an important factor in the final clinical outcome [ 17 ••]. The study found that 50% of the subjects that underwent to a successful recanalization were able to be functionally independent at 90 days.…”