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.

中文翻译：

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急性缺血性卒中患者机械取栓后的血压变异性和短期结局

目标

评估机械血栓切除术 (MT) 后血压 (BP) 控制对大血管闭塞 (LVO) 急性缺血性卒中 (AIS) 患者短期临床结果的影响的数据有限。我们旨在调查 MT 后血压变化与卒中早期结果的关联。

材料和方法

对在三级中心接受 MT 超过 3.5 年的 LVO AIS 患者进行了一项回顾性研究。在 MT 后的前 24 小时和 48 小时内记录每小时的 BP 数据。BP 变异性表示为 BP 分布的四分位数范围 (IQR)。短期有利结果定义为改良 Rankin 量表 (mRS) 0-3、出院回家或住院康复设施 (IRF)。

结果

在 95 名入选受试者中，37 名 (38.9%) 出院时结局良好，8 名 (8.4%) 死亡。调整混杂因素后，MT 后最初 24 小时内收缩压 (SBP) IQR 的增加显示与有利结果显着负相关（OR 0.43，95% CI [0.19，0.96]，p = 0.039）。MT 后前 24 小时内 MAP 中位数增加与有利结果相关（OR 1.75，95% CI [1.09，2.83]，p = 0.021）。亚组分析再次证明，在血运重建成功的患者中，SBP IQR 增加与有利结果之间存在显着负相关（OR 0.48，95% CI [0.21，0.97]，p = 0.042）。

结论

无论再通状态如何，MT 后高 SBP 变异性与 LVO 的 AIS 患者较差的短期结果相关。MAP 值可用作功能预后的指标。