Pre-endovascular therapy change in blood pressure is associated with outcomes in patients with stroke

Mistry, Eva; Dakay, Katarina; Petersen, Nils; Jayaraman, Mahesh; McTaggart, Ryan; Furie, Karen L.; Mistry, Akshitkumar M.; Mehta, Tapan; Arora, Niraj; Rosa, Felipe De Los Rios La; Starosciak, Amy; Siegler, James E.; Barnhill, Natasha R; Patel, Kishan; Assad, Salman; Tarboosh, Amjad; Cruz, Aurora S; Wagner, Jeffrey C.; Fortuny, Enzo; Bennett, Alicia; James, Robert F.; Jagadeesan, Bharathi; Streib, Christopher; Kasner, Scott E.; Weber, Stuart; Chitale, Rohan; Volpi, John; Mayer, Stephan A.; Khatri, Pooja; Yaghi, Shadi

doi:10.1136/jnnp-2019-322534

Cited by 2 publications

(3 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…26,62 One study has found that large drops or increases in pre-EVT mean arterial BP are associated with worse patient outcomes. 63 These findings suggest that BP reductions before EVT could exacerbate ischemia, while BP increase may indicate failure of compensatory mechanisms to maintain blood flow to the ischemic tissue.…”

Section: Acute Bp Management In the Setting Of Reperfusion Treatmentmentioning

confidence: 87%

See 1 more Smart Citation

Blood Pressure Management for Ischemic Stroke in the First 24 Hours

Bath

Song

Silva

et al. 2022

Stroke

Self Cite

View full text Add to dashboard Cite

High blood pressure (BP) is common after ischemic stroke and associated with a poor functional outcome and increased mortality. The conundrum then arises on whether to lower BP to improve outcome or whether this will worsen cerebral perfusion due to aberrant cerebral autoregulation. A number of large trials of BP lowering have failed to change outcome whether treatment was started prehospital in the community or hospital. Hence, nuances on how to manage high BP are likely, including whether different interventions are needed for different causes, the type and timing of the drug, how quickly BP is lowered, and the collateral effects of the drug, including on cerebral perfusion and platelets. Specific scenarios are also important, including when to lower BP before, during, and after intravenous thrombolysis and endovascular therapy/thrombectomy, when it may be necessary to raise BP, and when antihypertensive drugs taken before stroke should be restarted. This narrative review addresses these and other questions. Although further large trials are ongoing, it is increasingly likely that there is no simple answer. Different subgroups of patients may need to have their BP lowered (eg, before or after thrombolysis), left alone, or elevated.

show abstract

Section: Acute Bp Management In the Setting Of Reperfusion Treatmentmentioning

confidence: 87%

“…26,62 One study has found that large drops or increases in pre-EVT mean arterial BP are associated with worse patient outcomes. 63…”

Section: Pre-evtmentioning

confidence: 99%

Blood Pressure Management for Ischemic Stroke in the First 24 Hours

Bath

Song

Silva

et al. 2022

Stroke

Self Cite

View full text Add to dashboard Cite

show abstract

“…Post-stroke BP fluctuations represent a multifactorial and intricate physiological process ( 6 ). Numerous studies have revealed the correlation between preoperative, intraoperative, and postoperative BP levels and clinical outcomes as an crucial clinical factor ( 7 , 8 ). While prior studies have emphasized the importance of BP in the prognosis of AIS ( 9 ), the optimal BP target for AIS patients remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

Machine learning models reveal the critical role of nighttime systolic blood pressure in predicting functional outcome for acute ischemic stroke after endovascular thrombectomy

Xu,

Qi,

Liu

et al. 2024

Front. Neurol.

View full text Add to dashboard Cite

BackgroundBlood pressure (BP) is a key factor for the clinical outcomes of acute ischemic stroke (AIS) receiving endovascular thrombectomy (EVT). However, the effect of the circadian pattern of BP on functional outcome is unclear.MethodsThis multicenter, retrospective, observational study was conducted from 2016 to 2023 at three hospitals in China (ChiCTR2300077202). A total of 407 patients who underwent endovascular thrombectomy (EVT) and continuous 24-h BP monitoring were included. Two hundred forty-one cases from Beijing Hospital were allocated to the development group, while 166 cases from Peking University Shenzhen Hospital and Hainan General Hospital were used for external validation. Postoperative systolic BP (SBP) included daytime SBP, nighttime SBP, and 24-h average SBP. Least absolute shrinkage and selection operator (LASSO), support vector machine-recursive feature elimination (SVM-RFE), Boruta were used to screen for potential features associated with functional dependence defined as 3-month modified Rankin scale (mRS) score ≥ 3. Nine algorithms were applied for model construction and evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy.ResultsThree hundred twenty-eight of 407 (80.6%) patients achieved successful recanalization and 182 patients (44.7%) were functional independent. NIHSS at onset, modified cerebral infarction thrombolysis grade, atrial fibrillation, coronary atherosclerotic heart disease, hypertension were identified as prognostic factors by the intersection of three algorithms to construct the baseline model. Compared to daytime SBP and 24-h SBP models, the AUC of baseline + nighttime SBP showed the highest AUC in all algorithms. The XGboost model performed the best among all the algorithms. ROC results showed an AUC of 0.841 in the development set and an AUC of 0.752 in the validation set for the baseline plus nighttime SBP model, with a brier score of 0.198.ConclusionThis study firstly explored the association between circadian BP patterns with functional outcome for AIS. Nighttime SBP may provide more clinical information regarding the prognosis of patients with AIS after EVT.

show abstract

Pre-endovascular therapy change in blood pressure is associated with outcomes in patients with stroke

Cited by 2 publications

References 7 publications

Blood Pressure Management for Ischemic Stroke in the First 24 Hours

Blood Pressure Management for Ischemic Stroke in the First 24 Hours

Machine learning models reveal the critical role of nighttime systolic blood pressure in predicting functional outcome for acute ischemic stroke after endovascular thrombectomy

Contact Info

Product

Resources

About