Adverse Outcomes Associated With Higher Mean Blood Pressure and Greater Blood Pressure Variability Immediately After Successful Embolectomy in Those With Acute Ischemic Stroke, and the Influence of Pretreatment Collateral Circulation Status

Abstract

Background To investigate whether collateral status could modify the associations between post‐thrombectomy blood pressure (BP) measures and outcomes. Methods and Results Patients with anterior‐circulation large‐vessel‐occlusion successfully recanalized in a multicenter endovascular thrombectomy registry were enrolled. Pretreatment collateral status was graded and dichotomized (good/poor) in angiography. Maximum, minimum, and mean systolic BP (SBP) and BP variability (assessed by the SD, coefficient of variation) during the initial 24 hours after endovascular thrombectomy were obtained. The primary outcome was unfavorable 90‐day outcome (modified Rankin Scale score 3–6). Secondary outcomes included symptomatic intracranial hemorrhage and 90‐day mortality. Adjusted odds ratios (aOR) of BP parameters over the outcomes were obtained in all patients and in patients with good/poor collaterals. Among 596 patients (mean age 66 years; 59.9% males), 302 (50.7%) patients had unfavorable 90‐day outcome. In multivariable analyses, higher mean SBP (aOR, 1.59 per 10 mm Hg increment; 95% CI, 1.26–2.02; P <0.001), mean SBP >140 mm Hg (versus ≤120 mm Hg; aOR, 4.27; 95% CI, 1.66–10.97; P =0.002), and higher SBP SD (aOR, 1.08 per 1‐SD increment; 95% CI, 1.01–1.16; P =0.02) were respectively associated with unfavorable 90‐day outcome in patients with poor collateral but not in those with good collateral. A marginal interaction between SBP coefficient of variation tertiles and collaterals on 90‐day functional outcome ( P for interaction, 0.09) was observed. A significant interaction between SBP coefficient of variation tertiles and collaterals on 90‐day mortality ( P for interaction, 0.03) was observed. Conclusions Higher postprocedural BP is associated with 90‐day unfavorable outcomes after successful endovascular thrombectomy in patients with poor collateral. Registration URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR1900022154.

Hemodynamics of Leptomeningeal Collaterals after Large Vessel Occlusion and Blood Pressure Management with Endovascular Treatment

“…106 This issue has recently gained interest with studies showing that poor baseline collaterals can aggravate the deleterious effects of higher BP levels or higher BP variability on clinical outcomes. 51,77 The association between BP and stroke outcomes may also differ by baseline perfusion status, that is, the extent and grade of LMC and tissue perfusion. As discussed in the previous section, early infarct growth may be a function of time from onset, ischemic severity (i.e., baseline LMC perfusion), and tissue vulnerability.…”

Association of Blood Pressure Within 6 h After Endovascular Thrombectomy and Functional Outcomes in Ischemic Stroke Patients With Successful Recanalization

“…Therefore, other mechanisms may be responsible. One possibility is that ICA occlusion is associated with poor collateral circulation ( 19 ). Poor collateral circulation may compromise the body's ability to compensate for ICA occlusion, rendering tissues and vessels more sensitive to changes in perfusion.…”

A Presurgical Unfavorable Prediction Scale of Endovascular Treatment for Acute Ischemic Stroke

“…According to recent clinical trials that have used new neuroimaging methods or biological markers, many risk factors would indicate poor outcomes for patients who received EVT for acute ischemic stroke (AIS) (Brugnara et al, 2020;Liu et al, 2021). To be specific, the risk factors, including brain edema, reperfusion injury, high National Institutes of Health Stroke Scale (NIHSS) scores, and blood-brain barrier damage were all associated with unfavorable prognosis (Chen et al, 2019;Heo et al, 2019;Brugnara et al, 2020;Butler et al, 2020;Liu et al, 2021).…”

“…According to recent clinical trials that have used new neuroimaging methods or biological markers, many risk factors would indicate poor outcomes for patients who received EVT for acute ischemic stroke (AIS) (Brugnara et al, 2020;Liu et al, 2021). To be specific, the risk factors, including brain edema, reperfusion injury, high National Institutes of Health Stroke Scale (NIHSS) scores, and blood-brain barrier damage were all associated with unfavorable prognosis (Chen et al, 2019;Heo et al, 2019;Brugnara et al, 2020;Butler et al, 2020;Liu et al, 2021). Even though research focused on prediction models using neuroimaging markers, biological markers, and neurological impairments is increasing, these predictors could not be used to make presurgical clinical decisions because they are examined and interpreted mostly during or after treatment.…”

“…Although logistic regression (LR) is widely applied in calculating disease-associated risk predictors, it still has limitations: it cannot provide satisfying accuracy, and it struggles with large numbers of variables (Dreiseitl and Ohno-Machado, 2002). Therefore, a prognosis model that predicts mid-term/short-term outcomes established by machine learning algorithm in stroke field began to gain attention (Heo et al, 2019;Brugnara et al, 2020;Liu et al, 2021). Furthermore, machine learning algorithm is able to deal with a huge number of complex variables and provides specific numerical values of different predictors (Deng et al, 2018;He et al, 2020;Castaneda-Vega et al, 2021).…”