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Original research
Admission systolic blood pressure and outcomes in large vessel occlusion strokes treated with endovascular treatment
  1. Nitin Goyal1,
  2. Georgios Tsivgoulis1,2,3,
  3. Sulaiman Iftikhar1,
  4. Yasser Khorchid1,
  5. Muhammad Fawad Ishfaq1,
  6. Vinodh T Doss1,4,
  7. Ramin Zand1,
  8. Jason Chang1,
  9. Khalid Alsherbini1,
  10. Asim Choudhri5,
  11. Daniel Hoit4,
  12. Andrei V Alexandrov1,
  13. Adam S Arthur4,
  14. Lucas Elijovich1,4
  1. 1Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  2. 2Second Department of Neurology, “Attikon University Hospital”, School of Medicine, University of Athens, Athens, Greece
  3. 3International Clinical Research Center, St. Anne's Hospital, Brno, Czech Republic
  4. 4Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  5. 5Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  1. Correspondence to Dr Nitin Goyal, Department of Neurology, University of Tennessee Health Sciences Center, 855 Monroe Avenue, Suite #415, Memphis, TN 38163, USA; ngoyal{at}uthsc.edu

Abstract

Background and purpose High admission blood pressure (BP) levels have been associated with lower recanalization rates after endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO). We sought to evaluate the association of admission BP with early outcomes in patients with ELVO treated with EVT.

Methods Consecutive patients with AIS presenting with ELVO in a tertiary stroke center during a 4-year period were prospectively evaluated. Admission systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated cuff recordings. A blinded neuroradiologist calculated the final infarct volume (FIV) using standardized ABC/2 methodology. A favorable functional outcome (FFO) at 3 months was defined as modified Rankin Scale score of 0–2.

Results Our study population consisted of 116 patients with AIS (mean age 63±13 years, median NIH Stroke Scale score 17 points (IQR 14–21), median FIV 30 cm3 (IQR 8–94)). Higher admission SBP correlated with higher FIV (r +0.225; p=0.020). Patients with FFO had lower admission SBP (151±24 mm Hg vs 165±28 mm Hg; p=0.010), while admission SBP levels were higher in patients who died during hospitalization (169±34 mm Hg vs 156±24 mm Hg; p=0.043). A 10 mm Hg increment in admission SBP was independently (p=0.010) associated with an increase of 12 cm3 in FIV (95% CI 3 to 21) in multiple linear regression models adjusting for potential confounders. A 10 mm Hg increment in admission SBP was independently (p=0.012) associated with a lower likelihood of FFO at 3 months (OR 0.64; 95% CI 0.45 to 0.91) in multiple logistic regression models adjusting for potential confounders.

Conclusions Higher admission SBP is an independent predictor of increased FIV and lower likelihood of 3-month FFO in patients with ELVO treated with EVT.

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