SBP falls significantly in patients with AIS with large vessel occlusion who recanalize with IAT. While SBP in non-recanalized patients also drops from baseline, it occurs to a lesser degree and stays higher only for a short period of time before falling to similar levels as in recanalized patients.

Background: It is unknown if intraprocedural blood pressure (BP) influences clinical outcomes and what BP parameter best predicts outcomes in acute ischemic stroke (AIS) patients who undergo intra-arterial therapy (IAT) for emergent large vessel occlusion. Methods: We retrospectively reviewed 147 patients who underwent IAT for anterior circulation AIS from January 2008 to December 2012 at our institution. Baseline demographics, stroke treatment variables, and detailed intraprocedural hemodynamic variables were collected. Results: The entire cohort consisted of 81 (55%) females with a mean age of 66.9 ± 15.6 years and a median National Institutes of Health Stroke Scale (NIHSS) score of 16 (IQR 11-21). Thirty-six (24.5%) patients died during hospitalization, 25 (17%) achieved a 30-day modified Rankin Scale score of 0-2, and 24 (16.3%) suffered symptomatic parenchymal hematoma type 1/2 hemorrhage. Patients who achieved a good outcome had a significantly lower admission NIHSS score, a higher baseline CT ASPECTS score, and a lower rate of ICA terminus occlusions. Successful recanalization was more frequent in the good-outcome group, while symptomatic hemorrhages occurred only in poor-outcome patients. The first systolic BP (SBP; 146.5 ± 0.2 vs. 157.7 ± 25.6 mm Hg, p = 0.042), first mean arterial pressure (MAP; 98.1 ± 20.8 vs. 109.7 ± 20.3 mm Hg, p = 0.024), maximum SBP (164.6 ± 27.6 vs. 180.9 ± 18.3 mm Hg, p = 0.0003), and maximum MAP (125.5 ± 18.6 vs. 138.5 ± 24.6 mm Hg, p = 0.0309) were all significantly lower in patients who achieved good outcomes. A lower maximum intraprocedural SBP was an independent predictor of good outcome (adjusted OR 0.929, 95% CI 0.886-0.963, p = 0.0005). Initial NIHSS score was the only other independent predictor of a good outcome. Conclusion: Lower intraprocedural SBP was associated with good outcome in patients undergoing IAT for AIS, and maximum SBP was an independent predictor of good outcome. SBP may be the optimal hemodynamic variable to monitor intraprocedurally during IAT and may predict outcome.

Introduction: Arterial recanalization with intravenous thrombolysis early for acute ischemic stroke (AIS) has been reported to be associated with spontaneous blood pressure (BP) reduction compared to those without recanalization. We investigated the course of BP after intra-arterial therapy (IAT) for AIS. Methods: Retrospective study from 1/08-12/12 of AIS patients who underwent IAT for ICA/M1 occlusions with TICI 0 flow was conducted. Cases under general anesthesia were excluded. BP recorded before, and at hourly intervals for 36 hours post procedure was collected. The average hourly BP, and the difference in hourly BP from pre-procedure baseline was calculated and compared by recanalization status. Successful recanalization was defined as TICI2b-3. Results: Sixty-two patients consisting of 37 (59.7%) with TICI2b-3 (Group R) and 25 with TICI 0-2a (Group NR) recanlization were included. Baseline characteristics were similar except for greater frequency of IV tPA administration in group R (51.3% vs. 20.8%, p 0.017). Average systolic BP (SBP) pre-procedure was similar in both both groups (R 158 vs NR 154 mm Hg, p 0.521). SBP decreased significantly at the end of procedure in both groups (Fig a,b), but without inter-group difference (Fig c). With time however, there was significantly lower average SBP, and greater SBP drop from baseline in the R group compared to NR group, but this persisted only till hour 12. (Fig 1c,d) Similar trend was observed with the mean arterial BP. Conclusions: BP after IAT differed significantly based on recanalization status and the difference was early. Endogenous drive to increase BP to maintain cerebral perfusion may account for the findings. This may have implications for BP management post IAT.