Prognostic significance of early systolic blood pressure variability after endovascular thrombectomy and intravenous thrombolysis in acute ischemic stroke: A systematic review and meta‐analysis

Qin, Jingcui; Zhang, Zhijun

doi:10.1002/brb3.1898

Cited by 16 publications

(13 citation statements)

References 31 publications

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“…BPV, reflecting the extent of BP fluctuations, has been regarded as a novel risk factor for worse outcome, brain oedema and HT after stroke 23–26. Previous studies suggested that increased BPV was associated with worse outcome in patients who had an AIS treated with recombinant tissue plasminogen activator (rt-PA) 23 26–28. Moreover, the finding that increased postprocedural BPV was associated with worse outcome has also been reported in studies of patients treated with MT 29 30.…”

Section: Discussionmentioning

confidence: 92%

“…Accordingly, BP fluctuation may directly worsen the extent of injury to the ischaemic penumbra, leading to the growth of the infarct core, and hence worse functional outcome. 27 28 Another possible explanation might be that higher BPV may contribute to a greater disruption of blood brain barrier (BBB) and lead to exacerbation of reperfusion injury. 13 Previous research suggested that higher BPV might increase the permeability of the BBB and the risk of haemorrhage transformation.…”

Section: Discussionmentioning

confidence: 99%

“…To data, the pathophysiology between intraprocedural BPV and outcome of patients who had an AIS following MT has not yet been fully elucidated, but a commonly accepted hypothesis holds that cerebral autoregulation is impaired in patients with LVO, increased BPV may lead to instability of cerebral perfusion due to the impairment in cerebral autoregulation. Accordingly, BP fluctuation may directly worsen the extent of injury to the ischaemic penumbra, leading to the growth of the infarct core, and hence worse functional outcome 27 28. Another possible explanation might be that higher BPV may contribute to a greater disruption of blood brain barrier (BBB) and lead to exacerbation of reperfusion injury 13.…”

Section: Discussionmentioning

confidence: 99%

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Increased blood pressure variability during general anaesthesia is associated with worse outcomes after mechanical thrombectomy: a prospective observational cohort study

Jin

Chen

et al. 2022

BMJ Open

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ObjectivesOptimal periprocedural blood pressure (BP) management during mechanical thrombectomy (MT) for acute ischaemic stroke is still controversial. The aim of this study was to investigate the association between intraprocedural BP variability (BPV) and outcomes in patients with large vessel occlusion (LVO) following MT with general anaesthesia.DesignA prospective observational cohort study.SettingThis study was conducted in a single tertiary hospital of Hangzhou in Zhejiang province.ParticipantsA total of 141 patients with LVO treated with MT were finally included between January 2018 and September 2020.Main outcome measuresIntraprocedural BP was recorded every 5 min throughout the procedure. BPV was measured as SD, coefficient of variation (CV), max-min (RANGE) and successive variation. Haemorrhagic transformation was assessed on 24-hour CT images according to European Cooperative Acute Stroke Study III trial. Poor functional outcome was defined as 90-day modified Rankin Scale score 3–6. Binary logistic regression analysis was used to investigate the association of BPV parameters with the incidence of parenchymal haemorrhage (PH) and poor functional outcome.ResultsAfter controlling for age, female, history of smoking, hypertension and atrial fibrillation, baseline National Institutes of Health Stroke Scale, baseline systolic BP (SBP), baseline Alberta Stroke Program Early CT Score, bridging thrombolysis and times of retrieval attempts, the results demonstrated that intraprocedural SBPRANGE (OR 1.029; 95% CI 1.003 to 1.055; p=0.027), SBPSD (OR 1.135; 95% CI 1.023 to 1.259; p=0.017) and SBPCV (OR 1.189; 95% CI 1.053 to 1.342; p=0.005) were independently associated with poor functional outcome. However, the independent association between intraprocedural BPV and PH at 24 hours has not been established in this study.ConclusionsIncreased intraprocedural BPV was more likely to have poor functional outcome in patients with LVO following MT with general anaesthesia. This finding indicates that special precautions should be taken to minimise BP fluctuation during procedure.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Increased blood pressure variability during general anaesthesia is associated with worse outcomes after mechanical thrombectomy: a prospective observational cohort study

Jin

Chen

et al. 2022

BMJ Open

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“…Two meta-analysis described an association between the variability of the SBP and a poor clinical result 45 , 46 , but no association with the 90-day mortality 46 . Further meta-analyses confirmed a significant association of increased SBP after MT 47 or pre- and post-interventional 9 with a poor clinical result. In addition, increased post-interventional systolic and diastolic BP values were associated with increased mortality 9 .…”

Section: Discussionmentioning

confidence: 78%

Impact of leukoaraiosis or blood pressure on clinical outcome, mortality and symptomatic intracerebral hemorrhage after mechanical thrombectomy in acute ischemic stroke

Göthel-Ezzeiani

Jansen

Austein

et al. 2022

Sci Rep

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We aimed to study the impact of leukoaraiosis (LA) and blood pressure (BP) on clinical outcome, mortality and symptomatic intracerebral hemorrhage (sICH) in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT). We analyzed data retrospectively from 521 patients with anterior large vessel occlusion treated with MT. LA was dichotomized in 0–2 (absent-to-moderate) versus 3–4 (moderate-to-severe) according to the van Swieten scale. Various systolic (SBP) and diastolic (DBP) BP parameters during the first 24 h were collected. Multivariable logistic regressions were performed to identify predictors of a poor 90-day outcome, mortality and sICH. LA was significantly associated with poor outcome (OR 3.2; p < 0.001) and mortality (OR 3.19; p = 0.008), but not sICH (p = 0.19). Higher maximum SBP was significantly associated with poor outcome (OR per 10 mmHg increase = 1.21; p = 0.009) and lower mean DBP was a predictor of mortality (OR per 10 mmHg increase = 0.53; p < 0.001). In the univariate analysis high SBP variability was associated with poor outcome, mortality and sICH, but not in the multivariate model. There was no association between BP and sICH. Severity of LA, SBP variability, high maximum SBP and low DBP are associated with either poor outcome or mortality in AIS patients undergoing MT. However, neither LA nor BP were associated with sICH in our cohort. Thus, mechanisms of the negative impact on outcome remain unclear. Further studies on impact of BP course and its mechanisms and interventions are needed to improve outcome in patients undergoing MT.

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“…Recently, neurologists propose that BP variability (BPV) may also play a role in affecting clinical outcome for AIS patients, in addition to the absolute BP level [ 6 ]. It is expected that the ischemic tissue would be more susceptible to blood pressure fluctuation given the impairment of cerebral autoregulation by stroke [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Detrimental effect of increased blood pressure variability on clinical outcome in acute ischemic stroke treated with reperfusion therapy: a case control study

Qin

Zhang

2022

BMC Neurol

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Background Blood pressure variability (BPV) is related to clinical outcome in acute ischemic stroke (AIS) treated with reperfusion therapy, but still is not included in clinical practice. This study aims to associate BPV during the first week of AIS with the outcome at three months. Methods We included 236 AIS patients treated with reperfusion therapy, and then divided them into good outcome and poor outcome groups. BPV measurements, including standard deviation, coefficient of variation, average real variability (ARV), and range, were recorded at stages of 2 h, 24 h, and 7 days after reperfusion therapy, respectively. These measurements were compared between the two groups. Then, ROC curve analysis examined the ability of BPV measurements in differentiating good and poor outcome groups; logistic regression analysis detected variables associated with clinical outcome in all subjects. Results The good outcome group exhibited significantly less BPV at all stages relative to the poor outcome group. The BPV measurements exhibited the potential to differentiate the two groups by the ROC curve analysis, especially for those at the 24-h stage. Higher ARV of diastolic BP and higher range of systolic BP at the 24-h stage, together with greater disease severity at baseline, were associated with poor clinical outcome. Conclusions Greater BPV during the first week of AIS is associated with poor outcome for the patients treated with reperfusion therapy. The BPV measurements play an important role in modulating clinical outcome, and have the potential to be included in future AIS guidelines.

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Prognostic significance of early systolic blood pressure variability after endovascular thrombectomy and intravenous thrombolysis in acute ischemic stroke: A systematic review and meta‐analysis

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 16 publications

References 31 publications

Increased blood pressure variability during general anaesthesia is associated with worse outcomes after mechanical thrombectomy: a prospective observational cohort study

Increased blood pressure variability during general anaesthesia is associated with worse outcomes after mechanical thrombectomy: a prospective observational cohort study

Impact of leukoaraiosis or blood pressure on clinical outcome, mortality and symptomatic intracerebral hemorrhage after mechanical thrombectomy in acute ischemic stroke

Detrimental effect of increased blood pressure variability on clinical outcome in acute ischemic stroke treated with reperfusion therapy: a case control study

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