Mortality and Disability According to Baseline Blood Pressure in Acute Ischemic Stroke Patients Treated by Thrombectomy: A Collaborative Pooled Analysis

Maïer, Benjamin; Gory, Benjamin; Taylor, Guillaume; Labreuche, Julien; Blanc, Raphaël; Obadia, Michaël; Abrivard, Marie; Smajda, Stanislas; Desilles, Jean‐Philippe; Redjem, Hocine; Cicciò, Gabriele; Lukaszewicz, Anne Claire; Turjman, Francis; Riva, Roberto; Labeyrie, Paul Emile; Duhamel, Alain; Blacher, Jacques; Piotin, Michel; Lapergue, Bertrand; Mazighi, Mikaël; Decroix, Jean‐Pierre; Wang, Adrien; Évrard, Serge; Tchikviladzé, Maya; Bourdin, Frederic; Gonzalez‐Valcarcel, Jaime; Maria, Federico Di; Pico, Fernando; Rakotoharinandrasana, Haja; Tassan, Philippe; Poll, Roxanna; Corabianu, Ovide; Broucker, T. de; Smadja, Didier; Alamowitch, Sonia; Ille, Olivier; Manchon, Éric; Garcia, Pierre‐Yves

doi:10.1161/jaha.117.006484

Cited by 79 publications

(47 citation statements)

References 46 publications

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“…A French study of 1332 patients treated with EVT also reported a J-shaped relationship between SBP and mortality, with a nadir at 157 mm Hg, and a nonlinear relationship between SBP and functional outcome, with a threshold of >177 mm Hg for poor functional outcome. 8 This study also found no relation between low SBP and functional outcome, but SBP <110 mm Hg was associated with an increased risk of death. In various other studies, U-shaped relations of BP with clinical outcomes have been reported for patients with any ischemic stroke, 4 , 7 , 18 , 19 with both extremes of BP associated with poorer outcome, although the reported optimum SBPs varied substantially between studies, ranging from 120 to 130 mm Hg 7 , 19 to 156 to 220 mm Hg in another study.…”

Section: Discussionmentioning

confidence: 44%

“…Two other studies in patients treated with EVT or with ischemic stroke in general also failed to find an association between SBP and sICH. 4 , 8 …”

Section: Discussionmentioning

confidence: 99%

“… 6 In general populations of patients with acute ischemic stroke and in those with a large vessel occlusion, J- and U-shaped curves have been described for the relation between BP and clinical outcomes, where both low and high systolic BPs (SBP) were associated with poor outcome. 4 , 7 , 8 Given the wide range of reported optimum baseline SBP and diastolic BP (DBP) values, it is likely that optimal BP targets vary across patients and stroke subtypes. 6 In some studies, higher SBP was associated with an increased risk of sICH.…”

mentioning

confidence: 99%

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Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment

Berg

Venema

Mulder

et al. 2020

Stroke

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Background and Purpose: Optimal blood pressure (BP) targets before endovascular treatment (EVT) for acute ischemic stroke are unknown. We aimed to assess the relation between admission BP and clinical outcomes and successful reperfusion after EVT. Methods: We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, an observational, prospective, nationwide cohort study of patients with ischemic stroke treated with EVT in routine clinical practice in the Netherlands. Baseline systolic BP (SBP) and diastolic BP (DBP) were recorded on admission. The primary outcome was the score on the modified Rankin Scale at 90 days. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2B-3), symptomatic intracranial hemorrhage, and 90-day mortality. Multivariable logistic and linear regression were used to assess the associations of SBP and DBP with outcomes. The relations between BPs and outcomes were tested for nonlinearity. Parameter estimates were calculated per 10 mm Hg increase or decrease in BP. Results: We included 3180 patients treated with EVT between March 2014 and November 2017. The relations between admission SBP and DBP with 90-day modified Rankin Scale scores and mortality were J-shaped, with inflection points around 150 and 81 mm Hg, respectively. An increase in SBP above 150 mm Hg was associated with poor functional outcome (adjusted common odds ratio, 1.09 [95% CI, 1.04–1.15]) and mortality at 90 days (adjusted odds ratio, 1.09 [95% CI, 1.03–1.16]). Following linear relationships, higher SBP was associated with a lower probability of successful reperfusion (adjusted odds ratio, 0.97 [95% CI, 0.94–0.99]) and with the occurrence of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.06 [95% CI, 0.99–1.13]). Results for DBP were largely similar. Conclusions: In patients with acute ischemic stroke treated with EVT, higher admission BP is associated with lower probability of successful reperfusion and with poor clinical outcomes. Further research is needed to investigate whether these patients benefit from BP reduction before EVT.

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Section: Discussionmentioning

confidence: 44%

“…Two other studies in patients treated with EVT or with ischemic stroke in general also failed to find an association between SBP and sICH. 4 , 8 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment

Berg

Venema

Mulder

et al. 2020

Stroke

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“…For the analysis of the primary end point, an ordinal logistic regression (shift analysis of the mRS, with score 5 and 6 collapsed into a single group12) was performed, after checking that the assumption of proportional odds was fulfilled 13. We non‐parametrically examined the possibly non‐linear relationship between each BP‐derived variable (PP before MT2; mean PP during MT; coefficient of variability of the PP during MT) and each outcome with restricted cubic splines with 3 knots, corresponding to the 5th, 50th, and 95th percentiles of the BP‐derived variable. Tests for non‐linearity used the likelihood ratio test, comparing the model with only the linear term to the model with the linear and the cubic spline terms 14.…”

Section: Methodsmentioning

confidence: 99%

“…Recent evidence supports the impact of baseline systolic blood pressure (SBP) on mortality and functional outcome at 3 months in MT treated patients,2, 3 but data on the role of BP variability specifically during the procedure are sparse and limited. The definition of BP variability often differs across studies and the main hemodynamic parameters measured are SBP and mean arterial pressure 4.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Maïer

Turc

Taylor

et al. 2018

JAHA

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BackgroundStudies on the role of blood pressure (BP) variability specifically during mechanical thrombectomy (MT) are sparse and limited. Moreover, pulse pressure (PP) has not been considered as a potent hemodynamic parameter to describe BP variability during MT. We assessed the impact of PP variability on functional outcome in acute ischemic stroke patients with large vessel occlusion during MT.Methods and ResultsAcute ischemic stroke patients presenting with large vessel occlusion from January 2012 to June 2016 were included. BP data during MT were prospectively collected in the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Logistic regression models were used to assess the association between PP coefficients of variation and functional outcome at 3 months (modified Rankin Scale). Among the 343 included patients, PP variability was significantly associated with worse 3‐month modified Rankin Scale in univariable (odds ratio [OR]=1.56, 95% confidence interval [CI]: 1.24–1.96 per 1‐unit increase, P=0.0002) and multivariable ordinal logistic regression (adjusted OR=1.40, 95% CI: 1.09–1.79, P=0.008). PP variability was also associated with unfavorable outcome (modified Rankin Scale 3–6) in univariable (OR=1.53, 95% CI: 1.17–2.01, P=0.002) and multivariable analysis (adjusted OR=1.42, 95% CI: 1.02–1.98, P=0.04). There was an association between PP variability and 3‐month all‐cause mortality in univariable analysis (OR= 1.37, 95% CI: 1.01–1.85 per 1‐unit increase of the coefficient of variation of the PP, P=0.04), which did not remain significant after adjustment for potential confounders.Conclusions PP variability during MT is an independent predictor of worse clinical outcome in acute ischemic stroke patients. These findings support the need for a close monitoring of BP variability during MT. Whether pharmacological interventions aiming at reducing BP variability during MT could impact functional outcome needs to be determined.

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Combination of Plaque Characteristics, Pial Collaterals, and Hypertension Contributes to Misery Perfusion in Patients With Symptomatic Middle Cerebral Artery Stenosis

Liu

Luo

Wang

et al. 2019

Magnetic Resonance Imaging

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Background: Atherosclerotic plaque in the middle cerebral artery (MCA) is linked to ischemic stroke events, but the relationship between plaque characteristics and cerebral perfusion is unclear. Purpose: To investigate MCA plaque characteristics between intracranial atherosclerotic patients with and without hypoperfusion area, and to identify the variables affecting hypoperfusion volume. Study Type: Retrospective. Population: Seventy-one patients with MCA stenosis (>50%), and all with ischemic onset in recent 2 weeks. Field Strength/Sequence: 3.0T MRI / diffusion-weighted imaging (DWI), time-of-flight magnetic resonance angiography (TOF-MRA), inversion-recovery prepared sampling perfection with application-optimized contrast using different flip angle evolutions (IR-SPACE), dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI). Assessment: Plaque characteristics including eccentric index (EI), eccentricity, plaque length, and enhancement on MCA were measured on IR-SPACE. Pial collaterals (PCs) were evaluated on axial TOF-MRA source images. Time-to-maximum (Tmax) maps with a threshold more than 6 seconds were assessed by rapid processing of perfusion and diffusion (RAPID) software. Statistical Tests: Two independent-samples t-tests, Mann-Whitney U-test, chi-square test, Z test, univariate and multivariate logistic analysis, and receiver operating characteristic (ROC) curve were used. Results: Patients with hypoperfusion had fewer eccentric plaque, lower EI, longer plaque length, and poor PCs compared with those without (P = 0.002, 0.016, 0.003, and 0.001). Eccentricity, plaque length, PCs, and hypertension were the factors independently associated with the occurrence of hypoperfusion after adjustment for risk factors of cerebrovascular disease (P = 0.014, 0.017, 0.035, and 0.018). The area under the curve (AUC) (95% confidence interval) was 0.865 (0.763-0.934) for a combination of the above four variables, which was significantly higher than any variable alone (P < 0.001, 0.016, < 0.001, and < 0.001). Patients with lower EI, concentric morphology, and grade 2 enhancement trended to have larger hypoperfusion volume (P = 0.028, 0.037, and 0.009). Data Conclusion: Plaque eccentricity, plaque length, PCs, and hypertension showed an association with the occurrence of hypoperfusion.

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Mortality and Disability According to Baseline Blood Pressure in Acute Ischemic Stroke Patients Treated by Thrombectomy: A Collaborative Pooled Analysis

Cited by 79 publications

References 46 publications

Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment

Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Combination of Plaque Characteristics, Pial Collaterals, and Hypertension Contributes to Misery Perfusion in Patients With Symptomatic Middle Cerebral Artery Stenosis

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