J Stroke.  2018 Sep;20(3):373-384. 10.5853/jos.2018.01305.

Higher Blood Pressure during Endovascular Thrombectomy in Anterior Circulation Stroke Is Associated with Better Outcomes

• Pikija S
• Trkulja V
• Ramesmayer C
• Mutzenbach JS
• Killer-Oberpfalzer M
• Hecker C
• Bubel N
• Füssel MU
• Sellner J

• KMID: 2428772
• DOI: http://doi.org/10.5853/jos.2018.01305

Abstract

BACKGROUND AND PURPOSE
Reports investigating the relationship between in-procedure blood pressure (BP) and outcomes in patients undergoing endovascular thrombectomy (EVT) due to anterior circulation stroke are sparse and contradictory.
METHODS
Consecutive EVT-treated adults (modern stent retrievers, BP managed in line with the recommendations, general anesthesia, invasive BP measurements) were evaluated for associations of the rate of in-procedure systolic BP (SBP) and mean arterial pressure (MAP) excursions to >120%/ < 80% of the reference values (serial measurements at anesthesia induction) and of the reference BP/weighted in-procedure mean BP with post-procedure imaging outcomes (ischemic lesion volume [ILV], hemorrhages) and 3-month functional outcome (modified Rankin Scale [mRS], score 0 to 2 vs. 3 to 6).
RESULTS
Overall 164 patients (70.7% pharmacological reperfusion, 80.5% with good collaterals, 73.8% with successful reperfusion) were evaluated for ILV (range, 0 to 581 cm3) and hemorrhages (incidence 17.7%). Higher rate of in-procedure SBP/MAP excursions to >120% was independently associated with lower ILV, while higher in-procedure mean SBP/MAP was associated with lower odds of hemorrhages. mRS 0-2 was achieved in 75/155 (48.4%) evaluated patients (nine had missing mRS data). Higher rate of SBP/MAP excursions to >120% and higher reference SBP/MAP were independently associated with higher odds of mRS 0-2, while higher ILV was associated with lower odds of mRS 0-2. Rate of SBP/MAP excursions to < 80% was not associated with any outcome.
CONCLUSIONS
In the EVT-treated patients with BP managed within the recommended limits, a better functional outcome might be achieved by targeting in-procedure BP that exceeds the preprocedure values by more than 20%.

Keyword

Stroke; Mechanical thrombolysis; Blood pressure; Anesthesia, general

MeSH Terms

Adult
Anesthesia
Anesthesia, General
Arterial Pressure
Blood Pressure*
Hemorrhage
Humans
Mechanical Thrombolysis
Reference Values
Reperfusion
Stents
Stroke*
Thrombectomy*