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Eur J Neurol. 2019 Jul;26(7):1019-1027. doi: 10.1111/ene.13951. Epub 2019 Apr 23.

Associations of various blood pressure parameters with functional outcomes after endovascular thrombectomy in acute ischaemic stroke.

Author information

1
Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
2
Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
3
Clinical Research Center, Asan Medical Center, Seoul, Korea.

Abstract

BACKGROUND AND PURPOSE:

High blood pressure (BP) at presentation is associated with poor outcomes in acute ischaemic stroke, but serial BP measurements may better delineate the clinical implications of BP. The aim was to investigate the association between various BP parameters and functional outcomes in acute ischaemic stroke patients treated with endovascular thrombectomy (EVT).

METHODS:

This study reports a retrospective analysis of a prospective registry of a comprehensive stroke centre. Patients treated with EVT due to large vessel occlusion in the anterior circulation were enrolled. BP was measured hourly during the first 24 h after admission. Associations of various BP parameters, including BP variability, with functional outcomes at 3 months, including good outcomes (modified Rankin Scale score of 0-2), were analysed.

RESULTS:

Of the 378 enrolled patients (mean age 70 ± 11 years, male 54.2%), 313 (82.8%) achieved successful reperfusion after EVT, and 149 (39.4%) had good outcomes at 3 months. Higher mean systolic BP [each 10 mmHg increase, odds ratio 0.82 (0.69-0.97)] and higher systolic successive variation (SV) [each 10% increase, odds ratio 0.37 (0.18-0.76)] were associated with a reduced likelihood of achieving good outcomes. In addition, reperfusion status after EVT moderated the influence of higher systolic SV on good outcomes (Pint  = 0.05).

CONCLUSION:

The results showed that a higher mean systolic BP and systolic SV during the first 24 h of EVT reduced the likelihood of good outcomes at 3 months. The effects of these parameters on outcomes are more substantial amongst patients with successful reperfusion after EVT, suggesting that different BP control strategies should be employed according to reperfusion status.

KEYWORDS:

acute ischaemic stroke; blood pressure; blood pressure variability; endovascular thrombectomy; mean blood pressure; substantial reperfusion; successive variation

PMID:
30868681
DOI:
10.1111/ene.13951

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