Impact of blood pressure levels within first 24 hours after mechanical thrombectomy on clinical outcome in acute ischemic stroke patients

Abstract

IntroductionDespite early management and technical success of mechanical thrombectomy (MT) for acute ischemic stroke (AIS), not all patients reach a good clinical outcome. Different factors may have an impact and we aimed to evaluate blood pressure (BP) levels in the first 24 hours after MT.MethodsConsecutive AIS patients treated with MT were enrolled in the retrospective bi-center study. Neurological deficit was assessed with National Institutes of Health Stroke Scale (NIHSS) and functional outcome after 3 months with modified Rankin scale (mRS) with a score 0–2 for good outcome. The presence of symptomatic intracerebral hemorrhage (SICH) was assessed according to the SITS–MOST criteria.ResultsOf 703 treated patients, completed BP levels were collected in 690 patients (350 males, mean age 71±13 years) with median of admission NIHSS 17 points. Patients with mRS 0–2 had a lower median of systolic BP (SBP) compared with those with poor outcome (131 vs 140 mm Hg, P<0.0001). The rate of SICH did not differ between the patients with a median of SBP <140 mm Hg and ≥140 mm Hg. (5.1% vs 5.1%, P=0.980). Multivariate regression analysis with adjustment for potential confounders showed a median of distolic BP (P=0.024, OR: 0.977, 95% CI: 0.957 to 0.997) as a predictor of good functional outcome after MT, and a median of maximal SBP (P=0.038; OR: 0.990, 95% CI: 0.981 to 0.999) in the patients with achieved recanalization.ConclusionLowering of BP within the first 24 hours after MT may have a positive impact on clinical outcome in treated patients.

Blood pressure characteristics in patients with acute basilar artery occlusion undergoing endovascular thrombectomy

“…However, they could not find, at least in anterior circulation stroke, an association of intra-procedural BP indices and clinical outcome 17 . A recent study reported that a lower BP within the first 24 hours after EVT had positive impact on outcome, which further illustrates the complex interaction of BP at different time points and outcome in severe ischemic stroke 31 . Interestingly, in that study the rate of symptomatic ICH did not differ between the patients with a median of SBP < 140 mmHg and ≥140 mmHg, which could point at a higher relevance of intra-procedural compared to post-interventional phase for the development of hemorrhagic complications.…”

Cortical Neural Damage Associated with Cerebral Hyperperfusion after Reperfusion Therapy for Acute Ischemic Stroke: ¹²³I-iomazenil Single-photon Emission Computed Tomography Findings

“…Recent studies reported that lowering blood pressure after this treatment might have a positive impact on clinical outcome in acute ischemic stroke patients. 18,19) We speculate that lowering blood pressure may prevent exacerbation of CH after recanalization, so this could prevent neural damage. Another theory on the formation of CH is damage from free radicals.…”

Blood Pressure Management Before, During, and After Endovascular Thrombectomy for Acute Ischemic Stroke

“…7 Concurrently, evidence emerged that lowering BP, at least post-EVT, could provide some benefit. 46,58,59 With the conceptual progress offered by these studies, it further became clear that not all postthrombectomy patients should be treated equally, and survey data indicate that most practitioners decide treatment on a per-patient basis. 3 The most important factor affecting postthrombectomy BP management is recanalization status.…”