Intensive vs Conventional Blood Pressure Control After Thrombectomy in Acute Ischemic Stroke

Ghozy, Sherief; Mortezaei, Ali; Elfil, Mohamed; Abdelghaffar, Mariam; Kobeissi, Hassan; Aladawi, Mohammad; Abbas, Alzhraa S.; Nayak, Sandeep S.; Kadirvel, Ramanathan; Rabinstein, Alejandro A.; Kallmes, David F.

doi:10.1001/jamanetworkopen.2024.0179

Cited by 3 publications

References 32 publications

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Assessing Practice Variation of Anesthetic Management for Endovascular Thrombectomy in Acute Ischemic Stroke: A Comprehensive Multicenter Survey

Sharma,

Dube,

Esmail

et al. 2024

Journal of Neurosurgical Anesthesiology

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Objective: This study explored the current global landscape of periprocedural care of acute ischemic stroke patients undergoing endovascular thrombectomy (EVT). Methods: An anonymous, 54-question electronic survey was sent to 354 recipients in hospitals worldwide. The responses were stratified by World Bank country income level into high-income (HICs) and low/middle-income (LMICs) countries. Results: A total of 354 survey invitations were issued. Two hundred twenty-three respondents started the survey, and 87 fully completed surveys were obtained from centers in which anesthesiologists were routinely involved in EVT care (38 in HICs; 49 in LMICs). Respondents from 35 (92.1%) HICs and 14 (28.6%) LMICs reported that their centers performed >50 EVTs annually. Respondents from both HICs and LMICs reported low rates of anesthesiologist involvement in pre-EVT care, though a communication system was in place in 100% of HIC centers and 85.7% of LMIC centers to inform anesthesiologists about potential EVTs. Respondents from 71.1% of HIC centers and 51% of LMIC centers reported following a published guideline during EVT management, though the use of cognitive aids was low in both (28.9% and 24.5% in HICs and LMICs, respectively). Variability in multiple areas of practice, including choice of anesthetic techniques, monitoring and management of physiological variables during EVT, and monitoring during intrahospital transport, were reported. Quality metrics were rarely tracked or reported to the anesthesiology teams. Conclusions: This study demonstrated variability in anesthesiology involvement and in clinical care during and after EVT. Centers may consider routinely involving anesthesiologists in pre-EVT care, using evidence-based recommendations for EVT management, and tracking adherence to published guidelines and other quality metrics.

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Assessing Practice Variation of Anesthetic Management for Endovascular Thrombectomy in Acute Ischemic Stroke: A Comprehensive Multicenter Survey

Sharma,

Dube,

Esmail

et al. 2024

Journal of Neurosurgical Anesthesiology

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Magnitude of systolic blood pressure reduction following endovascular treatment and clinical outcomes in acute large artery occlusion stroke

Huang,

Ding,

Wang

et al. 2024

Stroke Vasc Neurol

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BackgroundThe impact of lowering systolic blood pressure (SBP) following endovascular treatment (EVT) in acute large vessel occlusion stroke (LVOS) patients remains unclear. We aimed to explore the effect of the magnitude of SBP reduction (SBPr) after EVT on outcomes in LVOS patients.MethodsWe consecutively registered patients at three comprehensive stroke centres who had experienced EVT as a result of acute anterior circulation LVOS. SBPr was calculated as follows: (baseline SBP−mean SBP/baseline SBP)×100%. The 90-day modified Rankin Scale score ranging from 0 to 2 was defined as a favourable functional outcome. Based on CT scans obtained within 24 hours after procedure, symptomatic intracranial haemorrhage (sICH) was assessed according to the criteria of the European Cooperative Acute Stroke Study III.ResultsWe enrolled 1080 patients, of which 908 (84.1%) had successful recanalisation. In the overall cohort, SBPr was correlated with lower odds of sICH (SBPr±10% as a reference, 20%–30%: OR 0.460; 95% CI: 0.245 to 0.864; p=0.016; >30%: OR 0.304; 95% CI 0.123 to 0.749; p=0.010). In patients who achieved successful reperfusion, SBPr>30% was correlated with higher odds of a poor outcome (SBPr±10% as a reference, OR 2.150; 95% CI 1.268 to 3.645; p=0.004) and SBPr has a similar tendency towards reducing the incidence of sICH. In the subgroup analyses, baseline Alberta Stroke Programme Early CT (ASPECT) score (pinteract=0.024) modified the effect of SBPr on the 90-day outcome.ConclusionAmong patients with EVT, a significant drop in SBP may be related to a poor functional outcome and a reduced incidence of sICH. Baseline ASPECT score may be an important interacting factor in the association of SBPr with the 90-day outcome. This study provides new insights for individualised BP management in patients with EVT.

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Efficacy and safety of Intensive Blood Pressure Control in Ischemic Stroke Patients Following Endovascular Thrombectomy: A Update Meta-Analysis

Zhou,

Yang

et al. 2024

Preprint

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Objective This meta-analysis aimed to determine the potential benefits or effectiveness of intensive blood pressure management in ischemic stroke patients who have undergone endovascular thrombectomy (EVT) and make an effective update for the evidence. Methods We comprehensively searched all relevant studies published before May 23, 2024, using multiple databases, including Cochrane Library, Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and Wangfang. The primary outcome was 90 days functional independence (Modified Rankin Scale, mRS score = 0–2), while the secondary outcomes comprised 90-day mortality, 7-day mortality, symptomatic intracranial hemorrhage (sICH), complications and hemicraniectomy. Results 17 studies with a total of 5825 patients were included. The primary outcome: 90 days functional independence, a significant difference between different blood pressure management (OR = 1.58, 95% CI [1.17, 2.13]) was observed, with obvious heterogeneity (I2 = 83.20%, p < 0.01). The secondary outcomes: The significant difference were found in 90-day mortality (OR = 0.75, 95% CI [0.58, 0.99]), sICH (OR = 0.74, 95% CI [0.58, 0.95]), hemicraniectomy (OR = 0.42, 95% CI [0.22, 0.81]). No significant difference were found in 7-day mortality (OR = 0.88, 95% CI [0.49, 1.58]), complications (OR = 1.32, 95% CI [0.50, 3.50]). Subgroup analysis for the heterogeneity. Conclusion Our results suggested that more intensive blood pressure management may yield greater benefits in terms of patients' clinic outcomes. However, the results should be interpreted cautiously. Additionally, blood pressure target of SBP < 140 mmHg may provide fundamental insights for future randomized controlled trials.

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Intensive vs Conventional Blood Pressure Control After Thrombectomy in Acute Ischemic Stroke

Cited by 3 publications

References 32 publications

Assessing Practice Variation of Anesthetic Management for Endovascular Thrombectomy in Acute Ischemic Stroke: A Comprehensive Multicenter Survey

Assessing Practice Variation of Anesthetic Management for Endovascular Thrombectomy in Acute Ischemic Stroke: A Comprehensive Multicenter Survey

Magnitude of systolic blood pressure reduction following endovascular treatment and clinical outcomes in acute large artery occlusion stroke

Efficacy and safety of Intensive Blood Pressure Control in Ischemic Stroke Patients Following Endovascular Thrombectomy: A Update Meta-Analysis

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