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Blood Pressure During Endovascular Treatment Under Conscious Sedation or Local Anesthesia
Noor Samuels1, Rob A van de Graaf2, Carlijn A L van den Berg2
1From the Departments of Radiology & Nuclear Medicine (N.S., R.A.v.d.G., C.A.L.v.d.B., B.R., A.v.d.L., A.C.G.M.v.E.), Public Health (D.N., H.F.L.), Anesthesiology (I.E.), and Neurology (N.S., R.A.v.d.G., B.R., D.W.J.D.), Erasmus MC, University Medical Center, Rotterdam; Departments of Radiology & Nuclear Medicine (K.M.T., B.J.E., C.B.L.M.M.) and Anesthesiology (R.V.I.), Amsterdam University Medical Center, University of Amsterdam; Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (W.H.v.Z.), Maastricht University Medical Center; Departments of Radiology and Nuclear Medicine (R.P.H.B., M.U.) and Neurology (M.U.), University Medical Center Groningen; Department of Radiology and Nuclear Medicine (B.A.A.M.v.H.), Isala, Zwolle; Department of Anesthesiology, Pain & Palliative Medicine (J.M.), Radboud UMC, University Medical Center, Nijmegen, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor. n.samuels@erasmusmc.nl.
Objective:
To evaluate the role of blood pressure (BP) as mediator of the effect of conscious sedation (CS) compared to local anesthesia (LA) on functional outcome after endovascular treatment (EVT).
Methods:
Patients treated in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry centers with CS or LA as preferred anesthetic approach during EVT for ischemic stroke were analyzed. First, we evaluated the effect of CS on area under the threshold (AUT), relative difference between baseline and lowest procedural mean arterial pressure (∆LMAP), and procedural BP trend, compared to LA. Second, we assessed the association between BP and functional outcome (modified Rankin Scale [mRS]) with multivariable regression. Lastly, we evaluated whether BP explained the effect of CS on mRS.
Results:
In 440 patients with available BP data, patients treated under CS (n = 262) had larger AUTs (median 228 vs 23 mm Hg*min), larger ∆LMAP (median 16% vs 6%), and a more negative BP trend (-0.22 vs -0.08 mm Hg/min) compared to LA (n = 178). Larger ∆LMAP and AUTs were associated with worse mRS (adjusted common odds ratio [acOR] per 10% drop 0.87, 95% confidence interval [CI] 0.78-0.97, and acOR per 300 mm Hg*min 0.89, 95% CI 0.82-0.97). Patients treated under CS had worse mRS compared to LA (acOR 0.59, 95% CI 0.40-0.87) and this association remained when adjusting for ∆LMAP and AUT (acOR 0.62, 95% CI 0.42-0.92).
Conclusions:
Large BP drops are associated with worse functional outcome. However, BP drops do not explain the worse outcomes in the CS group.
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