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Original research
Blood pressure levels post mechanical thrombectomy and outcomes in non-recanalized large vessel occlusion patients
  1. Nitin Goyal1,
  2. Georgios Tsivgoulis1,2,
  3. Abhi Pandhi1,
  4. Kira Dillard1,
  5. Diana Alsbrook1,
  6. Jason J Chang3,
  7. Balaji Krishnaiah1,
  8. Christopher Nickele4,
  9. Daniel Hoit4,
  10. Khalid Alsherbini1,
  11. Andrei V Alexandrov1,
  12. Adam S Arthur4,
  13. 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, National and Kapodistrian University of Athens, Athens, Greece
  3. 3Medstar Washington Hospital Medical Center, Washington, District of Columbia, USA
  4. 4Department of Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Neurologic and Spine Clinic, Memphis, Tennessee, USA
  1. Correspondence to Dr Nitin Goyal, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; ngoyal{at}uthsc.edu

Abstract

Objective Permissive hypertension may benefit patients with non-recanalized large vessel occlusion (nrLVO) post mechanical thrombectomy (MT) by maintaining brain perfusion. Data evaluating the impact of post-MT blood pressure (BP) levels on outcomes in nrLVO patients are scarce. We investigated the association of the post-MT BP course with safety and efficacy outcomes in nrLVO.

Methods Hourly systolic BP (SBP) and diastolic BP (DBP) values were prospectively recorded for 24 hours following MT in consecutive nrLVO patients. Maximum, minimum, and mean BP levels were documented. Three-month functional independence (FI) was defined as modified Rankin Scale (mRS) scores of 0–2.

Results A total of 88 nrLVO patients were evaluated post MT. Patients with FI had lower maximum SBP (160±19 mmHg vs 179±23 mmHg; P=0.001) and higher minimum SBP levels (119±12 mmHg vs 108±25 mmHg; P=0.008). Maximum SBP (183±20 mmHg vs 169±23 mmHg; P=0.008) and DBP levels (105±20 mmHg vs 89±18 mmHg; P=0.001) were higher in patients who died at 3 months while minimum SBP values were lower (102±28 mmHg vs 115±16 mmHg; P=0.007). On multivariable analyses, both maximum SBP (OR per 10 mmHg increase: 0.55, 95% CI 0.39 to 0.79; P=0.001) and minimum SBP (OR per 10 mmHg increase: 1.64, 95% CI 1.04 to 2.60; P=0.033) levels were independently associated with the odds of FI. Maximum DBP (OR per 10 mmHg increase: 1.61; 95% CI 1.10 to 2.36; P=0.014) and minimum SBP (OR per 10 mmHg increase: 0.65, 95% CI 0.47 to 0.90; P=0.009) values were independent predictors of 3-month mortality.

Conclusions Our study demonstrates that wide BP excursions from the mean during the first 24 hours post MT are associated with worse outcomes in patients with nrLVO.

  • blood pressure
  • outcome
  • systolic blood pressure
  • diastolic blood presure
  • mechanical thrombectomy
  • recanalization
  • emergent large vessel occlusion
  • stroke

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Footnotes

  • The study findings were partly presented at the Annual Meeting of the Society of Neurocritical Care, 2017.

  • Contributors NG: Study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content. GT: Analysis and interpretation, critical revision of the manuscript for important intellectual content. AP: Acquisition of data, critical revision of the manuscript for important intellectual content. KD: Acquisition of data, critical revision of the manuscript for important intellectual content. DA: Acquisition of data, critical revision of the manuscript for important intellectual content. JJC: Critical revision of the manuscript for important intellectual content. BK: Acquisition of data, critical revision of the manuscript for important intellectual content. CN: Acquisition of data, critical revision of the manuscript for important intellectual content. DH: Acquisition of data, critical revision of the manuscript for important intellectual content. KA: Critical revision of the manuscript for important intellectual content. AVA: Critical revision of the manuscript for important intellectual content. ASA: Acquisition of data, critical revision of the manuscript for important intellectual content. LE: Study concept and design, study supervision, critical revision of the manuscript for important intellectual content.

  • Competing interests DH: consultant for Codman Neurovascular, Medtronic, MicroVention, Penumbra, Sequent, and Stryker; ASA: consultant for Codman, Medtronic, Microvention, Penumbra, Sequent, Siemens, Stryker and has received research support from Sequent and Siemens; LE: consultant for Codman Neurovascular, Medtronic, MicroVention, Penumbra, Sequent, and Stryker.

  • Ethics approval University of Tennessee Health Sciences Center Acute Ischemic Stroke Database (10-01003-XP).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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