Background Recent randomized-controlled clinical trials (RCTs) have provided evidence that timely mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) is safe and improves functional outcomes. Numerous questions regarding the optimal management of LVO patients during the post-MT period have emerged and largely remain unanswered. Specifically, the optimal blood pressure (BP) management before and after the endovascular procedure is currently unclear. Higher pre-treatment BP (BP) levels have been recently associated with adverse outcomes in LVO patients treated with MT. However, there are scarce data evaluating the impact of post-MT BP levels on early outcomes of acute ischemic stroke (AIS) patients with LVO.
Methods Consecutive patients with LVO treated with MT during a 3 year period were evaluated. LVO patients with complete reperfusion following MT were stratified in 3 groups based on post-MT achieved BP goals: <140/90 mmHg (intensive), <160/90 mmHg (moderate) and <220/110 mmHg or <180/105 mmHg when pretreated with intravenous thrombolysis (permissive hypertension). Three-month functional independence was defined as modified-Rankin-Scale score of 0–2. Standard safety (3 months mortality and symptomatic intracranial hemorrhage [sICH]) and efficacy outcomes (3 months functional independence) were compared in three groups (intensive, moderate or permissive hypertension).
Results Our study population consisted of 217 AIS patients with LVO [mean age 62±14 years, 50% men, median NIHSS-score: 16 points (IQR 12–21)] who were treated with MT. Among patients with complete reperfusion (n=145) at the end of endovascular procedure (TICI 2b or 3), 10 patients achieved BP goal of <140/90 mmHg (intensive BP control), 36 patients achieved BP goal of <160/90 mmHg (moderate BP goal), while 94 patients were included in the permissive hypertension subgroup. Five patients were excluded from the analyses because of missing hourly BP recordings in the 24 hours post MT period. Three-month mortality was higher (p=0.008) in the permissive hypertension group (28.7%) in comparison to the groups of moderate (8.3%) and intensive BP (0%) control. In addition, three-month functional independence was lower (p=0.041) in the group of permissive hypertension (50.6%) in comparison to the groups of moderate (75.9%) and intensive BP (70.0%) control. The rates of sICH were similar among the three groups. In the multivariable logistic regression analysis, achieving a moderate BP goal of <160/90 mmHg during the first 24 hours following MT was independently associated with a lower likelihood of three-month mortality (OR: 0.08;95% CI: 0.01–0.54; p=0.010) in comparison to permissive hypertension.
Conclusion Our study provides preliminary data that a moderate BP control post MT is related to lower odds of three-month mortality in comparison to permissive hypertension. This observation requires independent confirmation in the setting of prospective, multi-center studies.
Disclosures A. Pandhi: None. N. Goyal: None. G. Tsigoulis: None. J. Chang: None. K. Dillard: None. M. Ishfaq: None. K. Nearing: None. A. Choudhri: None. D. Hoit: None. A. Alexandrov: None. A. Arthur: None. L. Elijovich: None. A. Alexandrov: None.
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