Blood Pressure after Endovascular Thrombectomy: Modeling for Outcomes Based on Recanalization Status

Marius Matusevicius, Charith Cooray, Matteo Bottai, Michael Mazya, Georgios Tsivgoulis, Ana Paiva Nunes, Tiago Moreira, Jyrki Ollikainen, Rosanna Tassi, Daniel Strbian, Danilo Toni, Staffan Holmin, Niaz Ahmed

Research output: Contribution to journalArticleScientificpeer-review

17 Citations (Scopus)

Abstract

Background and Purpose-The optimal level for blood pressure after endovascular thrombectomy in acute ischemic stroke is not well established. We sought to evaluate the association of post-endovascular thrombectomy systolic blood pressure (SBP) levels with clinical outcomes. Methods-We included endovascular thrombectomy-treated patients registered from 2014 to 2017 in the Safe Implementation of Treatments in Stroke International Thrombectomy Registry. The mean 24-hour SBP after endovascular thrombectomy treatment was analyzed both as a continuous variable and in intervals. The primary outcome was 3-month functional independence (modified Rankin Scale score of 0-2). The secondary outcomes were symptomatic intracerebral hemorrhage (SICH) and 3-month mortality. The SBP interval with the highest proportion of functional independence was chosen as reference. All analyses were performed for successful or unsuccessful recanalization (modified Treatment in Cerebral Ischemia score ≥2b or <2b, respectively). The results were adjusted for known confounders in logistic regression models. Results-In the multivariable analyses, a higher SBP value as a continuous variable was associated unfavorably with all outcomes in patients with successful recanalization (n=2920) and with more SICH in patients with unsuccessful recanalization (n=711). SBP interval ≥160 mm Hg was associated with less functional independence (adjusted odds ratio, 0.28 [95% CIs, 0.15-0.53]) and more SICH (adjusted odds ratio, 6.82 [95% CIs, 1.53-38.09]) compared with reference 100 to 119 mm Hg in patients with successful recanalization. SBP ≥160 mm Hg was associated with more SICH (adjusted odds ratio, 6.62 [95% CIs, 1.07-51.05]) compared with reference 120 to 139 mm Hg in patients with unsuccessful recanalization. Conclusions-Higher SBP values were associated with less functional independence at 3 months in patients with successful recanalization and with more SICH regardless of recanalization status.

Original languageEnglish
Pages (from-to)519-525
Number of pages7
JournalSTROKE
Volume51
Issue number2
DOIs
Publication statusPublished - 2020
Publication typeA1 Journal article-refereed

Keywords

  • blood pressure
  • brain ischemia
  • humans
  • odds ratio
  • thrombectomy

Publication forum classification

  • Publication forum level 2

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

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