Effect of Blood Pressure Management Strategies on Outcomes in Patients with Acute Ischemic Stroke After Successful Mechanical Thrombectomy

• Published in: World neurosurgery Vol. 148; pp. e635 - e642
• Main Authors: Gigliotti, Michael J., Padmanaban, Varun, Richardson, Alicia, Simon, Scott D., Church, Ephraim W., Cockroft, Kevin M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2021
• Subjects: Acute ischemic stroke; Blood pressure; Intracerebral hemorrhage; Malignant cerebral edema; Mechanical thrombectomy; Modified Rankin scale; Outcome; NIHSS; SBP; OR; CI; MT; AIS; IST; Malignant cerebral edema; Intracerebral hemorrhage; sICH; mRS; Acute ischemic stroke; Mechanical thrombectomy; Modified Rankin scale; Outcome; Blood pressure; BEST
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2021.01.052

Variability, with no general consensus, exists in how patients' blood pressure should be managed after successful mechanical thrombectomy (MT) for large vessel ischemic stroke. We examined whether exceeding the systolic blood pressure (SBP) targets in patients during the first 24 hours after successful MT led to worse outcomes.
We retrospectively studied a consecutive sample of adult patients who had undergone MT. We collected SBP data for the first 24 hours after MT and categorized the patients into 3 groups according to cases of the SBP exceeding 140, 160, or 180 mm Hg. The primary and secondary outcomes were the modified Rankin scale score at discharge and 90 days of follow-up, the incidence of symptomatic intracranial hemorrhage, malignant cerebral edema, and hemicraniectomy, mortality within 90 days, and discharge disposition.
A total of 117 patients were included (mean age, 65 ± 13.12 years; 53% female). The occurrence of ≥1 instance of SBP ≥180 mm Hg was significantly associated with poor functional outcomes at discharge (adjusted odds ratio [OR], 5.83; 95% confidence interval [CI], 1.41–32.9; P = 0.025) but not at 90 days of follow-up. The occurrence of SBP ≥160 mm Hg resulted in an independently increased odds of malignant cerebral edema (adjusted OR, 17.07; 95% CI, 2.56–174.4; P = 0.01), with a trend toward increased odds of symptomatic intracranial hemorrhage (adjusted OR, 4.42; 95% CI, 1.03–21.2; P = 0.0503).
These results suggest that individual instances of SBP elevation alone after successful MT, rather than a necessarily prolonged increased blood pressure as reflected by the mean or median SBP values, can significantly affect the clinical outcomes after successful MT.