High Systolic Blood Pressure after Successful Endovascular Treatment Affects Early Functional Outcome in Acute Ischemic Stroke

Abstract

Background: Endovascular treatment (EVT) has been shown to significantly improve functional outcome in patients with acute large cerebral vessel occlusions. To date, no evidence-based recommendations on blood pressure management after successful EVT exist. Previous studies showed an association between high pre-EVT systolic blood pressure (SBP) and functional outcome, but do not answer the question on how to manage blood pressure after successful recanalization. The purpose of this study was to determine the role of blood pressure measurements as a predictor for early functional outcome in patients with successful EVT. Methods: Prospectively derived data from patients with acute large vessel occlusion within the anterior circulation and EVT was analyzed in this monocentric study. Mean systolic- and maximum SBP as well as SBP-peaks have been obtained for the first 24 h after successful EVT. Predictive value of SBP for discharge modified Rankin Scale (mRS) ≤2 has been investigated using logistic regression models. Results: From 168 patients with successful EVT, 74 (44%) had a favorable outcome with an mRS ≤2. Mean- (127 vs. 131 mm Hg, p = 0.035) and maximum SBP (157 vs. 169 mm Hg, p < 0.001) as well as the number of SBP-peaks (0 vs. 1.5, p = 0.004) were lower in patients with favorable outcomes. Multivariable logistic regression showed high mean- and maximum SBP to predict unfavorable outcomes. Cutoff mean SBP was 141 mm Hg and maximum SBP 159 mm Hg. Conclusions: High SBP in the first 24 h after recanalization of acute anterior cerebral vessel occlusions is associated with unfavorable functional outcome. Interventional studies are needed to determine the role of SBP management as a modifiable parameter in the early phase after successful EVT.

Effect of short-term blood pressure variability on functional outcome after intra-arterial treatment in acute stroke patients with large-vessel occlusion

“…Although our study did not find the maximum SBP to be an influential factor for functional outcome, this may be related to our study subjects' characteristics. Our research found that the rate of successful recanalization was higher in the favorable outcome group, which also had lower maximum SBP, indirectly suggesting that patients with successful reperfusion are more likely to benefit from lower SBP [26].…”

Effects of hypertension in patients receiving mechanical thrombectomy

“…[ 45 ] Numerous studies have confirmed that hypertension and high blood pressure are associated with sICH and poor functional outcome in acute ischaemic stroke, [ 46 , 47 ] and higher maximum SBP was also associated with poor functional outcomes after MT. [ 36 ] The post hoc data analysis of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands reported that BP did not affect the benefit or safety of MT in patients with AIS, but it also confirmed a strong correlation between systolic blood pressure and functional outcomes in ischaemic stroke, and the association was U-shaped. Both low and high baseline mean SBP measurements were associated with poor functional outcomes.…”

Effect of short-term blood pressure variability on functional outcome after intra-arterial treatment in acute stroke patients with large-vessel occlusion

“…Our research found that the rate of successful recanalization was higher in the favorable outcome group, which also had lower maximum SBP. Patients with successful reperfusion are more likely to benefit from lower SBP [19]. Some studies showed that BP within the first 48 hours after a stroke showed a U-shaped correlation with clinical outcome [17,20], particularly in patients with non-recanalization.…”

“…The mean age was 64.8±10.9 years, and 27 (37.5%) were women. The median NIHSS score at admission was 14 points [IQR, [9][10][11][12][13][14][15][16][17][18][19], while the median ASPECTS was 8 points [IQR, [7][8][9]. Of the 72 patients, 86.1% patients achieved recanalization (TICI 2b or 3).…”