Periprocedural Hypotension and Functional Outcomes in Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

There is limited information on systemic blood pressure goals and variability before and during mechanical thrombectomy and how it affects outcomes in large vessel ischemic stroke.

A longitudinal cohort study of patients with acute ischemic stroke and large vessel occlusion who underwent thrombectomy at a comprehensive stroke center in southwestern Colombia (January 2017-January 2023). Two groups were defined: group H (hypotension before thrombectomy, defined as >30 mmHg systolic blood pressure drop between arrival and anesthesia induction) and no hypotension (NH) group. Primary outcomes included functional status (modified Rankin Scale score, 0-2 favorable; 3-6 unfavorable) and mortality (modified Rankin scale score = 6) at discharge and 90-day follow-up. Inverse probability weighting was used to reduce confounding.

A total of 167 patients (44.3% female), median age 66 (interquartile range, 53-76), underwent thrombectomy. Admission National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score were similar (16.5 versus 16; Alberta Stroke Program Early Computed Tomography Score 9 in both). Thrombolysis was used in 45.4% (H: 23.3% versus NH: 22.1%). Door-to-needle time: 56 minutes versus 47 minutes; door-to-groin: 138 minutes versus 129.5 minutes. Procedure duration was longer in H (100 minutes versus 85 minutes). Successful reperfusion was not significantly different (modified Thrombolysis in Cerebral Infarction≥2b) 73.05% (H: 76.6%, NH: 70%, P = 0.29). Unfavorable modified Rankin scale score at discharge: H: 70.1%, NH: 68.9% (P = 0.86). Mortality at discharge: H: 32.5%, NH: 16.7% (P = 0.2); at 90 days: H: 37.7%, NH: 18.9% (P = 0.02) with inverse probability weighting analysis showing higher mortality in H both at discharge (odds ratio [OR] = 2.16, 95% CI: 0.93-5.04, P = 0.07) and 90 days (OR = 2.93, 95% CI: 1.25-6.86, P = 0.01) only the latter with statistical significance.

Hypotension before thrombectomy in large vessel occlusion stroke was associated with increased 90-day mortality. Worse functional outcomes were also observed, though not statistically significant. Early blood pressure control during anesthetic induction may improve prognosis.