Systolic blood pressure variability following endovascular thrombectomy and clinical outcome in acute ischemic stroke: A meta‐analysis

Abstract

Blood pressure variability (BPV) has been linked with the outcome of acute ischemic stroke (AIS) after endovascular thrombectomy (EVT). However, the association of the stroke outcome with specific short‐term BPV parameters is unclear. We did a systematic literature search for studies published from January 2010 to September 2020. Eligibility criteria included studies with (1) AIS patients treated with EVT with or without thrombolysis; and (2) analysis of the association between short‐term systolic BPV parameter and clinical outcomes. Systolic BPV parameters included standard deviation (SD), coefficient of Variation (CoV), successive Variation (SV), and Variation independent of mean. A total of 11 studies were meta‐analyzed, comprising 3520 patients who underwent EVT. Lower odds of achieving good functional outcome at 3 months; that is, modified Rankin Scale (mRS) score ≤2 was associated with SD (OR, 0.854; p = .02), CoV (OR, 0.572; p = .04), SV (OR 0.41; p = .00) of systolic blood pressure (SBP). Likewise, higher odds of one‐point increase in mRS score was associated with SD (OR 1.42; p = .03), CoV (OR 1.464; p = .00) and SV (OR 2.605; p = .00) of SBP. However, high BPV was not associated with symptomatic intracranial hemorrhage and all‐cause mortality at 90 days. The association of BPV and early neurological deterioration was inconclusive. Based on the available studies, short‐term systolic BPV is indicative of the clinical outcome of patients following EVT in AIS. Further research should focus on personalized blood pressure management strategies, rather than a one‐size‐fits‐all approach.

Blood pressure variability related to early outcome of acute ischemia stroke in a prospective observational study

“…Nepal et al pointed out that patients with a large coefficient of variation in blood pressure had a greater pressure on the vascular endothelium of the collateral circulation, which would more easily accelerate bleeding and affect the prognosis. [ 18 ] In addition, Kolyviras et al suggested that patients with large variations in blood pressure levels might increase shear force in the vasculature by upregulating endothelial cytokines, thereby inducing vascular inflammation, destroying the blood–brain barrier, promoting the formation of atherosclerotic plaques, and destroying the prognosis. [ 19 ] In addition, increased BPV can impair cerebral autoregulation in acute ischemic brain regions.…”

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

“…Every 5-mmHg increase in the pulse pressure variability was related to a 36% decrease in the likelihood of independent functional outcome and a 60% increase in the odds of mortality at three months of stroke onset [ 18 ]. Furthermore, a meta-analysis suggests that systolic BPV measurements during the first 24 h after EVT, including SD, CV, and successive variation, is indicative of clinical outcome at three months of stroke onset [ 19 ]. Therefore, maintaining less BPV at 24-h stage, relative to other stages, is particularly essential in promoting better clinical outcome in AIS.…”

Association between systolic blood pressure parameters and unexplained early neurological deterioration (UnND) in acute ischemic stroke patients treated with mechanical thrombectomy

“…Despite successful recanalization via MT, some patients develop early neurological deterioration (ND). An increase in ⩾4 points of the National Institutes of Health Stroke Scale (NIHSS) between pretreatment and Day 1 is commonly considered as an early ND, 1 – 4 though for minor stroke patients an increase in ⩾2 points of the NIHSS is considered as ND. 1 – 5 Several studies demonstrated that early or subacute ND is a strong predictor of poor stroke outcomes.…”

“…An increase in ⩾4 points of the National Institutes of Health Stroke Scale (NIHSS) between pretreatment and Day 1 is commonly considered as an early ND, 1 – 4 though for minor stroke patients an increase in ⩾2 points of the NIHSS is considered as ND. 1 – 5 Several studies demonstrated that early or subacute ND is a strong predictor of poor stroke outcomes. 6 Apart from obvious causes such as lack of recanalization, parenchymal hemorrhage, malignant edema, or procedural complications, ND might remain unexplained in over half of cases (UnND).…”

“… 6 Apart from obvious causes such as lack of recanalization, parenchymal hemorrhage, malignant edema, or procedural complications, ND might remain unexplained in over half of cases (UnND). 2 – 4 Although hemodynamic factors are suspected as important mechanisms of ND, this has not been directly examined to date. Therefore, there are currently no management guidelines for UnND.…”