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Ischemic Stroke
Original research
Association of maximal systolic blood pressure with poor outcome in patients with hyperattenuated lesions on immediate NCCT after mechanical thrombectomy
  1. Xinfa Ding1,
  2. Chao Xu2,
  3. Wansi Zhong2,
  4. Xiaoxian Gong2,
  5. Ying Zhou2,
  6. Zhicai Chen2,
  7. Min Lou2
  1. 1 Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
  2. 2 Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
  1. Correspondence to Dr Zhicai Chen, Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China; chenzhicai{at}zju.edu.cn

Abstract

Background and purpose This study aimed to investigate the relationship between blood pressure (BP) management and clinical outcome in patients with hyperattenuated lesions on non-contrast CT (NCCT) immediately after mechanical thrombectomy (MT).

Methods We retrospectively reviewed our prospectively collected cohort for consecutive patients with acute ischemic stroke (AIS) who received MT between October 2013 and July 2018. Hourly systolic BP (SBP) and diastolic BP (DBP) values were recorded for 24 hours following MT, and then maximum SBP (SBPmax) and DBP (DBPmax) values were identified. Poor outcome was defined as 3-month modified Rankin score (mRS) 3–6 and parenchymal hemorrhage (PH) was defined according to the European Cooperative Acute Stroke Study (ECASS) II trial. Associations of BP parameters with poor outcome and PH were determined using binary logistic regression models. Receiver operating characteristics (ROC) curve analysis was used to determine the predictive value of BP.

Results Initially 262 patients with AIS who received MT were reviewed and 148 patients with hyperattenuated lesions on immediate NCCT were enrolled in the final cohort for analysis. Binary logistic regression showed that every 10 mm Hg increase in SBPmax was independently associated with a poor outcome (OR 1.426; 95% CI 1.095 to 1.855; p=0.008) and PH (OR 1.025; 95% CI 1.005 to 1.480; p=0.044). SBP ≤140 mm Hg during the post-procedural 24-hour period was associated with lower odds of a poor outcome and PH compared with the other group.

Conclusions Control of maximal SBP within 24 hours might be related to a low rate of PH and poor outcome in patients with hyperattenuated lesions on immediate NCCT after intervention.

  • CT
  • thrombectomy
  • intervention

https://doi.org/10.1136/neurintsurg-2019-014846

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    Footnotes

    • XD and CX contributed equally.

    • Contributors XD: substantial contributions to study design, image data collection for the whole trial, data analysis and interpretation of data, revising the manuscript for intellectual content. CX: substantial contributions to study design, wrote the statistical analysis plan, cleaned and analysed the data, drafting/revising the manuscript for intellectual content. WZ: data acquisition, interpretation of data, revising the manuscript for intellectual content. XG: data acquisition, revising the manuscript for intellectual content. YZ: data acquisition, revising the manuscript for intellectual content. ZC: study concept/design, study supervision, interpretation of data, revising the manuscript critically for intellectual content, final approval of the version to be published. ML: initiated the collaborative project, monitored data collection for the whole trial, revising the manuscript critically for intellectual content. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This study was supported by the National Natural Science Foundation of China (81601017, 81622017, 81471170), the National Key Research and Development Program of China (2016YFC1301503), the Science Technology Department of Zhejiang Province (2018C04011), Fundamental Research Funds for the Central Universities (2017XZZX002-09).

    • Competing interests None declared.

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

    • Data sharing statement There are no additional unpublished data available.

    • Patient consent for publication Not required.