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Real-Time Monitoring and Modulation of Blood Pressure in a Rabbit Model of Ischemic Stroke
Published on: February 10, 2023
Blood pressure variability and short-term outcomes after mechanical thrombectomy in patients with acute ischemic
Jiping Zhou1, Heba Samara2, Ali Ebrahim3
1Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, MI, USA.
Objectives:
There is limited data evaluating effects of post-mechanical thrombectomy (MT) blood pressure (BP) control on short-term clinical outcomes in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). We aim to investigate the association of BP variations, after MT, with stroke early outcomes.
Materials And Methods:
A retrospective study was conducted on AIS patients with LVO undergoing MT at a tertiary center over 3.5 years. Hourly BP data was recorded within the first 24- and 48-hours post-MT. BP variability was expressed as the interquartile range (IQR) of BP distribution. Short-term favorable outcome was defined as modified Rankin scale (mRS) 0-3, discharge to home or inpatient rehabilitation facility (IRF).
Results:
Of the 95 enrolled subjects, 37(38.9%) had favorable outcomes at discharge and 8 (8.4%) died. After adjustment for confounders, an increase in IQR of systolic blood pressure (SBP) within the first 24 hours after MT revealed a significant inverse association with favorable outcomes (OR 0.43, 95% CI [0.19, 0.96], p = 0.039). Increased median MAP within the first 24 hours after MT correlated with favorable outcomes (OR 1.75, 95% CI [1.09, 2.83], p = 0.021). Subgroup analysis redemonstrated significant inverse association between increased SBP IQR and favorable outcomes (OR 0.48, 95% CI [0.21, 0.97], p = 0.042) among patients with successful revascularization.
Conclusions:
Post-MT high SBP variability was associated with worse short-term outcomes in AIS patients with LVO regardless of recanalization status. MAP values may be used as indicators for functional prognosis.
Insights
High blood pressure variability after mechanical thrombectomy for acute ischemic stroke is linked to poorer outcomes. Mean arterial pressure may predict functional prognosis in these patients.
Area of Science:
- Neurology
- Cardiology
- Critical Care Medicine
Background:
- Mechanical thrombectomy (MT) is a key treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO).
- Limited data exists on the impact of post-MT blood pressure (BP) control on short-term clinical outcomes in AIS patients with LVO.
Purpose of the Study:
- To investigate the association between BP variations after MT and early stroke outcomes in AIS patients with LVO.
- To evaluate the role of BP variability and mean arterial pressure (MAP) in predicting short-term functional prognosis.
Main Methods:
- Retrospective study of AIS patients with LVO undergoing MT.
- Analysis of hourly BP data within 24 and 48 hours post-MT.
- BP variability quantified by interquartile range (IQR); favorable outcome defined as modified Rankin Scale (mRS) 0-3.
Main Results:
- Increased systolic BP (SBP) IQR within 24 hours post-MT was inversely associated with favorable outcomes (OR 0.43).
- Increased median MAP within 24 hours post-MT correlated with favorable outcomes (OR 1.75).
- High SBP variability showed inverse association with favorable outcomes even in patients with successful revascularization.
Conclusions:
- Elevated post-MT SBP variability is associated with worse short-term outcomes in AIS patients with LVO.
- MAP may serve as a prognostic indicator for functional recovery after MT.
- Optimizing BP management post-MT is crucial for improving patient outcomes.
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