@article {Treurnietneurintsurg-2017-012988, author = {Kilian M Treurniet and Olvert A Berkhemer and Rogier V Immink and Hester F Lingsma and Vivian M C Ward-van der Stam and Markus W Hollmann and Jaap Vuyk and Wim H van Zwam and Aad van der Lugt and Robert J van Oostenbrugge and Diederik W J Dippel and Jonathan M Coutinho and Yvo B W E M Roos and Henk A Marquering and Charles B L M Majoie}, editor = {, and Dippel, Diederik W J and Lugt, Aad van der and Majoie, Charles B L M and Roos, Yvo B W E M and van Oostenbrugge, Robert J and van Zwam, Wim H and Berkhemer, Olvert A and Fransen, Puck S S and Beumer, Debbie and van den Berg, Lucie A and Schonewille, Wouter J and Vos, Jan Albert and Majoie, Charles B L M and Roos, Yvo B W E M and Nederkoorn, Paul J and Wermer, Marieke J H and Walderveen, Marianne A A van and van Oostenbrugge, Robert J and van Zwam, Wim H and Staals, Julie and Hofmeijer, Jeannette and van Oostayen, Jacques A and Nijeholt, Geert J Lycklama {\`a} and Boiten, Jelis and Dippel, Diederik W J and Brouwer, Patrick A and Emmer, Bart J and de Bruijn, Sebastiaan F and van Dijk, Lukas C and Kappelle, L Jaap and Lo, Rob H and van Dijk, Ewoud J and de Vries, Joost and de Kort, Paul L M and van den Berg, Jan S P and van Rooij, Willem Jan J and van Hasselt, Boudewijn A A M and Aerden, Leo A M and Dallinga, Ren{\'e} J and Visser, Marieke C and Bot, Joseph C J and Vroomen, Patrick C and Eshghi, Omid and Schreuder, Tobien H C M L and Heijboer, Roel J J and Keizer, Koos and Tielbeek, Alexander V and Hertog, Heleen M den and Gerrits, Dick G and van den Berg-Vos, Renske M and Karas, Giorgos B and Majoie, Charles B L M and van Zwam, Wim H and van der Lugt, Aad and Nijeholt, Geert J Lycklama {\`a} and van Walderveen, Marianne A A and Bot, Joseph C J and Marquering, Henk A and Beenen, Ludo F and Sprengers, Marieke E S and Jenniskens, Sjoerd F M and van den Berg, Ren{\'e} and Berkhemer, Olvert A and Yoo, Albert J and Roos, Yvo B W E M and Koudstaal, Peter J and Boiten, Jelis and van Dijk, Ewoud J. and van Oostenbrugge, Robert J and Wermer, Marieke J H and Flach, H Zwenneke and Steyerberg, Ewout W and Lingsma, Hester F}, title = {A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia}, elocation-id = {neurintsurg-2017-012988}, year = {2017}, doi = {10.1136/neurintsurg-2017-012988}, publisher = {British Medical Journal Publishing Group}, abstract = {Background Up to two-thirds of patients are either dependent or dead 3 months after thrombectomy for acute ischemic stroke (AIS). Loss of cerebral autoregulation may render patients with AIS vulnerable to decreases in mean arterial pressure (MAP).Objective To determine whether a fall in MAP during intervention under general anesthesia (GA) affects functional outcome.Methods This subgroup analysis included patients from the MR CLEAN trial treated with thrombectomy under GA. The investigated variables were the difference between MAP at baseline and average MAP during GA (ΔMAP) as well as the difference between baseline MAP and the lowest MAP during GA (ΔLMAP). Their association with a shift towards better outcome on the modified Rankin Scale (mRS) after 90 days was determined using ordinal logistic regression with adjustment for prognostic baseline variables.Results Sixty of the 85 patients treated under GA in MR CLEAN had sufficient anesthetic information available for the analysis. A greater ΔMAP was associated with worse outcome (adjusted common OR (acOR) 0.95 per point mm Hg, 95\% CI 0.92 to 0.99). An average MAP during GA 10 mm Hg lower than baseline MAP constituted a 1.67 times lower odds of a shift towards good outcome on the mRS. For ΔLMAP this association was not significant (acOR 0.97 per mm Hg, 95\% CI 0.94 to 1.00, p=0.09).Conclusions A decrease in MAP during intervention under GA compared with baseline is associated with worse outcome.Trial registration number NTR1804; ISRCTN10888758; post-results.}, issn = {1759-8478}, URL = {https://jnis.bmj.com/content/early/2017/04/12/neurintsurg-2017-012988}, eprint = {https://jnis.bmj.com/content/early/2017/04/12/neurintsurg-2017-012988.full.pdf}, journal = {Journal of NeuroInterventional Surgery} }