Single mean arterial blood pressure drops during stroke thrombectomy under general anaesthesia are associated with poor outcome

Abstract

Background We examined the influence of periprocedural blood pressure (BP), especially critical BP drops, on 3-month functional outcome in stroke patients undergoing mechanical thrombectomy (MT) under general anaesthesia (GA). Methods We screened all patients with anterior circulation large vessel occlusion receiving MT under GA at our centre from January 2011 to June 2016 and selected those who had continuous invasive periinterventional BP monitoring. Clinical and radiological data were prospectively collected as part of an ongoing cohort study, monitoring data were extracted from electronic anaesthesia records. We used uni-and multivariable regression to investigate the association of BP values with unfavourable outcome, defined as modified Rankin Scale scores 3-6 3 months post-stroke. Results 115 patients were included in this study (mean age 65.3 ± 13.0 years, 55.7% male). Periinterventional systolic, diastolic, and mean arterial BP (MAP) values averaged across MT had no effect on outcome. However, single BP drops were related to unfavourable outcome, with absolute MAP drops showing the highest association compared to both systolic and relative BP drops (with reference to pre-interventional values). The BP value with the strongest association with unfavourable outcome was identified as an MAP ever < 60 mmHg (p = 0.01) with a pronounced effect in patients with poor collaterals. An MAP < 60 mmHg remained independently associated with poor functional outcome in multivariable analysis (p < 0.01). Conclusions For patients undergoing MT under GA, single MAP drops < 60 mmHg are independently related to unfavourable 3-month outcome. Therefore, every effort should be made to prevent periinterventional hypotensive episodes, especially below this threshold.

Anesthesia, Blood Pressure, and Socioeconomic Status in Endovascular Thrombectomy for Acute Stroke: A Single Center Retrospective Case Cohort

“…Consistent with previous studies, the multivariate analysis of our patient cohort identified age, baseline NIHSS, ASPECTS, and recanalization as predictive of functional outcomes after AIS 6,7,29–31. BP has been shown to be another modifiable factor influencing functional recovery after MT for AIS independent of anesthetic choice 29–34.…”

Hemodynamics of Leptomeningeal Collaterals after Large Vessel Occlusion and Blood Pressure Management with Endovascular Treatment

“…The effect of procedural BP during EVT is mostly analyzed in conjunction with the type of anesthesia; therefore, the BP profile in such reports cannot be entirely distinguished from its influence (Table 2). 40,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] It is not uncommon during general anesthesia (GA) to have hypotensive episodes due to anesthesia drugs, intravascular hypovolemia, high intrathoracic pressures, and impaired sympathetic tone. 62 GA is usually correlated with lower BP levels and unfavorable outcomes compared to local anesthesia or conscious sedation.…”

Impact of Early Blood Pressure Lowering in Patients Presenting with Acute Ischemic Stroke

“…Even single mean arterial blood pressure drop during mechanical thrombectomy under general anesthesia could result in poor neurologic outcome. In retrospective cohort study of 115 subjects that underwent to mechanical thrombectomy under general anesthesia, it was found that subjects that suffered from drops in the mean arterial blood pressure below 60 mmHg faced a worse outcome [ 13 ]. If mechanical thrombectomy will be performed under general anesthesia, the anesthesia team has to be aware that even short episodes of the hypotension during the general anesthesia induction can result in impairment of the collateral circulation.…”