Abstract TP4: Do Lower Blood Pressure Levels in the First 24 Hours After Mechanical Thrombectomy Have an Impact on the Short-Term Outcomes?

Abstract

Introduction: Mechanical thrombectomy (MT) is a part of the standard treatment of LVO stroke. Peri-interventional blood pressure variability may impact the outcomes of MT. In this study, we assessed whether lower mean blood pressure levels for longer than 12 hours has any impact on the short-term functional outcomes of MT. Methods: With the approval of the Human Studies Committee at the University of Louisville (IRB #: 13.0396), we performed a retrospective analysis of LVO stroke MT patients from 2016-18 (n=86). Blood pressure (BP) data collected at admission baseline, precanalization, immediate post-canalization, and 24 hours post-canalization. Baseline and post-canalization 24-hour BP data collected hourly. MBP lower than 20% of the “mean baseline” values recorded in the first few hours of admission was considered as “ clinically low ” BP, and a total of 12 hours of clinically low MBP levels within the first 24-hour of post-thrombectomy period was considered as “ potentially hypoperfused ”. Changes in NIHSS within the first 24 hours post canalization and NIHSS at discharge were assessed as main outcomes. Results: Mean age was 65±13 years. About 83% of patients TICI 2b/3 was accomplished. Baseline MBP levels were 103 ± 16mmHg. When the “ potentially hypoperfused ” patients (MBP<80 of baseline for >12 hours) were compared with the patients who were not (n=29 vs. n=57), the change in NIHSS at 24 hours and the NIHSS score at discharge were statistically significantly worse in patients who were potentially hypoperfused . (Table) Discussion: In this retrospective analysis, we assessed the contribution of clinically lower MBP levels after MT to the short-term functional outcome. Our preliminary results showed that the patients who were exposed to hypoperfusion for longer than 12 hours had worse NIHSS scores. Impact of maintaining baseline blood pressure needs to be further studied under prospective and controlled study designs.

Blood Pressure Management Following Large Vessel Occlusion Strokes: A Narrative Review

“…Intuitively, these patients may require higher blood pressure goals to ensure perfusion to the penumbra. Our group has demonstrated poor discharge outcomes among successfully recanalized patients who had sustained hypoperfusion for >12 hours, as well as those with higher blood pressure variability in the first 24 hours following MT ( 69 , 48 ). Similarly, in a post-hoc analysis of the BEST trial data, the patients with higher blood pressure variability within the first 24 hours had poor 90-day functional outcomes ( 49 ).…”