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Original research
Impact of blood pressure levels within first 24 hours after mechanical thrombectomy on clinical outcome in acute ischemic stroke patients
  1. David Cernik1,
  2. Daniel Sanak2,
  3. Petra Divisova2,
  4. Martin Kocher3,
  5. Filip Cihlar4,
  6. Jana Zapletalova5,
  7. Tomas Veverka2,
  8. Andrea Prcuchova1,
  9. Dusan Ospalik1,
  10. Marie Cerna3,
  11. Petra Janousova2,
  12. Michal Kral2,
  13. Tomas Dornak2,
  14. Vojtech Prasil3,
  15. David Franc2,
  16. Petr Kanovsky2
  1. 1Department of Neurology, Krajska zdravotni as Masarykova nemocnice v Usti nad Labem oz, Usti nad Labem, Czech Republic
  2. 2Department of Neurology, Univ Hosp Olomouc, Olomouc, Czech Republic
  3. 3Department of Radiology, Univ Hosp Olomouc, Olomouc, Czech Republic
  4. 4Department of Radiology, Krajska zdravotni as Masarykova nemocnice v Usti nad Labem oz, Usti nad Labem, Czech Republic
  5. 5Department of Biometry and Statistics, Palacký University Medical School, Olomouc, Czech Republic
  1. Correspondence to Dr Daniel Sanak, Department of Neurology, Univ Hosp Olomouc, Olomouc 779 00, Czech Republic; daniel.sanak{at}centrum.cz

Abstract

Introduction Despite early management and technical success of mechanical thrombectomy (MT) for acute ischemic stroke (AIS), not all patients reach a good clinical outcome. Different factors may have an impact and we aimed to evaluate blood pressure (BP) levels in the first 24 hours after MT.

Methods Consecutive AIS patients treated with MT were enrolled in the retrospective bi-center study. Neurological deficit was assessed with National Institutes of Health Stroke Scale (NIHSS) and functional outcome after 3 months with modified Rankin scale (mRS) with a score 0–2 for good outcome. The presence of symptomatic intracerebral hemorrhage (SICH) was assessed according to the SITS–MOST criteria.

Results Of 703 treated patients, completed BP levels were collected in 690 patients (350 males, mean age 71±13 years) with median of admission NIHSS 17 points. Patients with mRS 0–2 had a lower median of systolic BP (SBP) compared with those with poor outcome (131 vs 140 mm Hg, P<0.0001). The rate of SICH did not differ between the patients with a median of SBP <140 mm Hg and ≥140 mm Hg. (5.1% vs 5.1%, P=0.980). Multivariate regression analysis with adjustment for potential confounders showed a median of distolic BP (P=0.024, OR: 0.977, 95% CI: 0.957 to 0.997) as a predictor of good functional outcome after MT, and a median of maximal SBP (P=0.038; OR: 0.990, 95% CI: 0.981 to 0.999) in the patients with achieved recanalization.

Conclusion Lowering of BP within the first 24 hours after MT may have a positive impact on clinical outcome in treated patients.

  • ischemic stroke
  • mechanical thrombectomy
  • blood pressure level
  • symptomatic intracerebral hemorrhage
  • clinical outcome

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Footnotes

  • Patient consent for publication Not required.

  • Contributors DC, DS: study concept and design, acquisition of data, analysis and interpretation of data; drafting and critical revision of the manuscript for important intellectual content; and final approval of the version to be published. PD: acquisition of data, analysis and interpretation of data; drafting and critical revision of the manuscript for important intellectual content. MK, FC: acquisition of data, critical revision of the manuscript for important intellectual content. JZ: statistical analysis, interpretation of analysis. TV, AP, DO, MC, PJ, MK: acquisition of data, critical revision of the manuscript for important intellectual content. TD: acquisition of data, analysis and interpretation of data, drafting and critical revision of the manuscript for important intellectual content. VP, DF: acquisition of data, critical revision of the manuscript for important intellectual content. PK: critical revision of the manuscript for important intellectual content.

  • Funding This study was funded by IGA LF UP (grant number: 018_2018); Ministerstvo Zdravotnictví Ceské Republiky (grant number: 17-30101A); Krajska Zdravotní, a.s. (grant number: IGA-KZ-2017-1-2).

  • Competing interests None declared.

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

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