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Blood pressure reduction and outcome after endovascular therapy with successful reperfusion: a multicenter study
  1. Mohammad Anadani1,
  2. Adam S Arthur2,
  3. Ali Alawieh1,
  4. Yser Orabi1,
  5. Andrei Alexandrov3,
  6. Nitin Goyal3,
  7. Marios-Nikos Psychogios4,
  8. Ilko Maier5,
  9. Joon-tae Kim6,
  10. Saleh G Keyrouz7,
  11. Adam de Havenon8,
  12. Nils H Petersen9,
  13. Abhi Pandhi10,
  14. Christa B Swisher11,
  15. Ovais Inamullah11,
  16. Jan Liman12,
  17. Sreeja Kodali9,
  18. James A Giles7,
  19. Michelle Allen7,
  20. Stacey Q Wolfe13,
  21. Georgios Tsivgoulis14,
  22. Bradley A Cagle13,
  23. Chesney S Oravec13,
  24. Benjamin Gory15,
  25. Pierre De Marini15,
  26. Peter Kan16,
  27. Shareena Rahman11,
  28. Sébastien Richard17,
  29. Fábio A Nascimento18,
  30. Alejandro Spiotta1
  1. 1Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Neurosurgery, University of Tennessee Health Science Center, Memphis, Memphis, USA
  3. 3Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  4. 4Neuroradiology, University Medicine Goettingen, Goettingen, NS, Germany
  5. 5Neurology, University Medicine Goettingen, Goettingen, NS, Germany
  6. 6Chonnam, Korea (the Democratic People's Republic of)
  7. 7Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
  8. 8Department of Neurology, University of Utah, Salt Lake City, Utah, USA
  9. 9Yale Univ, New Heaven, Connecticut, USA
  10. 10Neurology, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
  11. 11Duke University Hospital, Durham, North Carolina, USA
  12. 12Department of Neurology, Universitatsklinikum Gottingen, Gottingen, Niedersachsen, Germany
  13. 13Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
  14. 14Second Department of Neurology, “Attikon” Hospital, School of Medicine, University of Athens, Athens, Greece
  15. 15Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
  16. 16Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  17. 17Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
  18. 18Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Mohammad Anadani, Medical University of South Carolina, Charleston, SC, USA; manadani{at}wustl.edu; Dr Alejandro Spiotta; spiotta{at}musc.edu

Abstract

Background Elevated systolic blood pressure (SBP) after mechanical thrombectomy (MT) correlates with worse outcome. However, the association between SBP reduction (SBPr) and outcome after successful reperfusion with MT is not well established.

Objective To investigate the association between SBPr in the first 24 hours after successful reperfusion and the functional and safety outcomes of MT.

Methods A multicenter retrospective study, which included 10 comprehensive stroke centers, was carried out. Patients with acute ischemic stroke and anterior circulation large vessel occlusions who achieved successful reperfusion via MT were included. SBPr was calculated using the formula 100×([admission SBP−mean SBP]/admission SBP). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3–6 at 90 days. Safety endpoints included symptomatic intracerebral hemorrhage, mortality, and requirement for hemicraniectomy during admission. A generalized mixed linear model was used to study the association between SBPr and outcomes.

Results A total of 1361 patients were included in the final analysis. SBPr as a continuous variable was inversely associated with poor outcome (OR=0.97; 95% CI 0.95 to 0.98; p<0.001) but not with the safety outcomes. Subanalysis based on reperfusion status showed that SBPr was associated with lower odds of poor outcome only in patients with complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI 3)) but not in patients with incomplete reperfusion (mTICI 2b). When SBPr was divided into categories (<1%, 1%–10%, 11%–20%, >20%), the rate of poor outcome was highest in the first group.

Conclusion SBPr in the first 24 hours after successful reperfusion was inversely associated with poor outcome. No association between SBPr and safety outcome was found.

  • blood pressure
  • stroke
  • thrombectomy
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Footnotes

  • Twitter @abhipandhi, @neurogiles

  • Contributors All authors have: provided a substantial contribution to the conception and design of the studies and/or the acquisition and/or the analysis of the data and/or the interpretation of the data. They have drafted the work or revised it for significant intellectual content and approved the final version of the manuscript. They agree to be accountable for all aspects of the work, including its accuracy and integrity.

  • 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 AS has honoris for consulting for Penumbra and Cerenovus. M-NP received honoraria; modest; received speakers’ honoraria from Siemens Healthineers.SQW reports U24NS107235- 01 NIH/NINDS StrokeNET Site Co-I. The other authors report no conflicts.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request.

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