Postreperfusion Blood Pressure Variability After Endovascular Thrombectomy Affects Outcomes in Acute Ischemic Stroke Patients With Poor Collateral Circulation

Abstract

Background and Purpose: We evaluated the effect of 24 h blood pressure variability (BPV) on clinical outcomes in acute ischemic stroke patients with successful recanalization after endovascular recanalization therapy (ERT). Methods: Patients with anterior circulation occlusion were evaluated if they underwent ERT based on multiphase computed tomography angiography and achieved successful recanalization (≥thrombolysis in cerebral ischemia 2b). Collateral degrees were dichotomized based on the pial arterial filling score, with a score of 0–3 defined as a poor collateral status. BPV parameters include mean, standard deviation, coefficient of variation, and variation independent of the mean (VIM) for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure, and pulse rate (PR). These parameters were measured for 24 h after ERT and were analyzed according to occlusion sites and stroke mechanisms. Associations of BPV parameters with clinical outcomes were investigated with stratification based on the baseline collateral status. Results: BPV was significantly different according to the occlusion sites and stroke mechanisms, and higher BPV was observed in patients with internal carotid artery occlusion or cardioembolic occlusion. After adjustment for confounders, most BPV parameters remained significant to predict functional outcomes at 3 months in patients with poor collateral circulation. However, no significant association was found between BPV parameters and clinical outcomes in patients with good collateral circulation. Conclusion: Postreperfusion BP management by decreasing BPV may have influence on improving clinical outcome in cases of poor collateral circulation among patients achieving successful recanalization after ERT.

Prognostic significance of early systolic blood pressure variability after endovascular thrombectomy and intravenous thrombolysis in acute ischemic stroke: A systematic review and meta‐analysis

“…Chang et al. (2019) reported that BPV during 48 hr after EVT remained significant to predict functional outcomes at 3 months in AIS patients with poor collateral circulation, whereas no significant association was found between BPV parameters and clinical outcomes in patients with good collateral circulation. Cho and Kim (2019) showed no significant association between SBPV during the first 24 hr after EVT and functional outcomes at 3 months in AIS patients.…”

“…Both of the studies showed a significant moderate effect of reperfusion status on the associations between SBPV and functional outcomes. Moreover, Chang et al reported significant associations between BPV and worse functional outcomes at 3 months in AIS patients with poor collateral circulation after EVT, whereas no significant associations were showed between BPV and clinical outcomes in AIS patients with good collateral circulation (Chang et al., 2019). In summary, the damage severity in cerebral autoregulation might moderate the pathophysiological influence of BPV on brain tissue.…”

“…Previous studies indicated that successful vessel recanalization can mainly be attributed to SBP decrement after EVT (Mattle et al., 2005). Recent studies showed that lower BPV is also related to better recanalization (Chang et al., 2018, 2019). Additionally, recanalization status might have an influence on the relationship between BP and functional outcomes after either EVT or IVT thrombolysis (Cho & Kim, 2019; Gerschenfeld et al., 2017; Martins et al., 2016).…”

Spontaneous systolic blood pressure drop early after mechanical thrombectomy predicts dramatic neurological recovery in ischaemic stroke patients

“…Previous studies have reported association of BP variability after MT with poor outcome 14,15 but this association was only verified in patients without successful recanalisation or with successful recanalisation but poor collaterals. If recanalisation is not achieved, the ischaemic area is more susceptible to BP changes due to the impaired cerebral autoregulation.…”

Management of Elevated Blood Pressure After Stroke Thrombectomy for Anterior Circulation

“… 39 For patients with successful reperfusion after MT, higher BP variability was observed to have a harmful influence on outcomes in those with poor collaterals. 40 …”