Even Small Decreases in Blood Pressure during Conscious Sedation Affect Clinical Outcome after Stroke Thrombectomy: An Analysis of Hemodynamic Thresholds

Abstract

A ≥10% mean arterial pressure drop from baseline is a strong risk factor for poor outcome in a homogeneous population of patients with stroke undergoing thrombectomy under sedation. This threshold could guide hemodynamic management of patients during sedation and general anesthesia.

The influence of blood pressure management on neurological outcome in endovascular therapy for acute ischaemic stroke

“…4 Collectively, the findings from the recent single centre randomised trials suggest that meticulous haemodynamic management with the aim to avoid SBP<140 mm Hg might be an important component in preventing poor outcome after EVT. 4e6 Several retrospective analyses have suggested hypotension and unstable haemodynamics as mechanisms responsible for the negative outcome associated with GA. 7À9,11,14,22 Specifically, decreases in blood pressure below certain thresholds, 9,14 reduction in blood pressure of different magnitudes, 7,22 and measures of blood pressure variability 8,11 have all been reported to influence outcome.…”

A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia

“…Further, falls in blood pressure also seem to predispose to worse outcomes in patients undergoing intervention under conscious sedation 29. In this light, one might even postulate that the lack of difference in outcome between the GA and conscious sedation groups in the recently published Sedation versus Intubation for Endovascular Stroke TreAtment (SIESTA, NCT02126085) trial can partly be explained by the lack of difference in blood pressure levels between the trial arms 30…”

Off‐hour admission and impact on neurological outcome in endovascular treatment for acute ischemic stroke

“…In the present study, perioperative blood pressure control was less effective during off-hours, mandating an improvement, as hypotension is known to be associated with worse neurological outcome. [20][21][22][23] In the other studies mentioned, data on intraoperative variables such as anesthesia technique, perioperative blood pressure and blood glucose are missing, limiting the comparisons with the present study.…”

“…Median age of the whole cohort was 71 (64-79) years and 58% were male ( Table 1). Median NIHSS was 20 (16)(17)(18)(19)(20)(21)(22)(23). Sixty-one patients (31%) were admitted via a regional hospital and 101 (52%) of all patients received IVT before EVT.…”