Exploring the optimal lower blood pressure boundary during endovascular thrombectomy in patients with large vessel...

Area of Science:

• Neurology
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Current guidelines recommend maintaining blood pressure (BP) below 180/105 mmHg during endovascular therapy (EVT).
• The optimal lower BP boundary during EVT is not well-established and is largely based on expert consensus.
• This study investigates the relationship between specific lower BP targets and functional outcomes after EVT.

Purpose of the Study:

• To determine the correlation between various lower boundary targets for systolic BP (SBP) and diastolic BP (DBP) during EVT and 3-month functional outcomes.
• To explore the association between periprocedural BP variability and functional outcomes following EVT.

Main Methods:

• A cohort study involving 201 patients with large artery occlusion undergoing EVT within 8 hours of stroke onset.
• Mean BP values during EVT were recorded, and logistic regression models were used to assess the association between BP targets and outcomes.
• Analysis also included the relationship between BP variability and functional outcomes.

Main Results:

• An SBP higher than 130 or 140 mmHg was independently associated with improved functional outcomes at 3 months (aOR 2.34-2.80).
• SBP exceeding 130 mmHg correlated with decreased 3-month mortality (aOR 0.24).
• Higher periprocedural SBP variability was linked to poorer functional outcomes (aOR 0.42). No significant association was found for DBP targets.

Conclusions:

• A systolic BP range above 130-140 mmHg may represent a safe lower boundary during EVT.
• Minimizing BP fluctuations during EVT could be crucial for improving functional outcomes.
• These findings suggest potential adjustments to BP management strategies during EVT.