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  • A 10% blood pressure drop from baseline during mechanical thrombectomy for stroke is strongly associated with worse neurological outcomes

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Ischemic Stroke
Original research
A 10% blood pressure drop from baseline during mechanical thrombectomy for stroke is strongly associated with worse neurological outcomes
  1. Arnaud Valent1,
  2. Amard Sajadhoussen2,
  3. Benjamin Maier3,
  4. Bertrand Lapergue4,
  5. Marc-Antoine Labeyrie5,
  6. Peggy Reiner6,
  7. Arturo Consoli7,
  8. Marc Fischler2,
  9. Etienne Gayat1,8,
  10. Morgan Leguen2
  1. 1 Department of Anesthesiology and Critical Care, DMU Parabol, AP HP.Nord, Université de Paris, Paris, France, Hôpital Lariboisière, Paris, France
  2. 2 Anesthesiology Department, Hopital Foch, Suresnes, France
  3. 3 Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
  4. 4 Stroke Center Neurology Division, Hopital Foch, Suresnes, France
  5. 5 Neuroradiology, Groupe hospitalier Lariboisiere Fernand-Widal, Paris, France
  6. 6 Departement of Neurology, Hopital Lariboisiere, Paris, France
  7. 7 Neuroradiology Department, Hopital Foch, Suresnes, France
  8. 8 MASCOT, UMR-S 742, INSERM, Paris, France
  1. Correspondence to Professor Etienne Gayat, Anesthesiology, Hôpital Lariboisière, Paris 75475, France; etienne.gayat{at}aphp.fr

Abstract

Background Mechanical thrombectomy (MT) for acute ischemic stroke can be performed under local anesthesia, with or without conscious sedation (CS), or under general anesthesia (GA). The hemodynamic consequence of anesthetic drugs may explain why GA may be associated with worse outcomes. We evaluated the association between hypotension duration during MT and the 90 day functional outcome under both anesthetic regimens.

Methods Patients were included in this retrospective study if they had an ischemic stroke treated by MT under GA or CS. The main exposure variable was the time below 90% of the reference value of arterial pressure measured before MT. The primary outcome was poor functional outcome defined as a 90 day modified Rankin Score ≥3.

Results 371 patients were included in the study. GA was performed in 42%. A linear association between the duration of arterial hypotension and outcome was observed. The odds ratio for poor functional outcome of 10 min under 90% of the baseline mean arterial pressure was 1.13 (95% CI 1.06 to 1.21) without adjustment and 1.11 (95% CI 1.02 to 1.21) after adjustment for confounding factors. The functional outcome was poorer for patients treated under GA compared with CS, but the association with the depth of hypotension remained similar under both conditions.

Conclusion In this study, we observed a linear association between the duration of hypotension during MT and the functional outcome at 90 days. An aggressive and personalized strategy for the treatment of hypotension should be considered. Further trials should be conducted to address this question.

  • thrombectomy
  • ischemic stroke
  • blood pressure
  • disability
  • mortality

https://doi.org/10.1136/neurintsurg-2019-015247

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    Footnotes

    • Contributors AV, AS: performed the literature search, the acquisition and interpretation of data for the work, drafted the manuscript and revised it critically, provided final approval of the version to be published. BM: performed the literature search, interpretation of data for the work, drafted the manuscript and revised it critically, provided final approval of the version to be published. BL, EG and ML: performed the conception and design of the work, the literature search, the acquisition and interpretation of data for the work, drafted the manuscript and revised it critically, provided final approval of the version to be published. M-AL, PR and AC: performed the literature search, the acquisition and interpretation of data for the work, revised the manuscript critically, provided final approval of the version to be published. MF: performed the conception and design of the work, the interpretation of data for the work, drafted the manuscript and revised it critically, provided final approval of the version to be published. EG is the guarantor of this work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests EG received consultancy fees from Magnisense and Adrenomed and research grant from Retia Medical.

    • Ethics approval This study was approved by the ethical committee (CERAR IRB 00010254-2018-006 and 00010254-2018-180) and Commission Nationale Informatique et Libertés (2059798v0).

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

    • Data sharing statement Data from the present study are available upon request from the corresponding author.

    • Patient consent for publication Not required.