Abstract 120: Systolic Blood Pressure Trajectories 72 Hours After Mechanical Thrombectomy Are Associated With Poor Functional Outcome: A Multicenter Analysis of Individual Patient Blood Pressure Data
Year: 2020
Type: conference-abstract
Abstract: Introduction: Blood pressure (BP) is an important modifiable parameter after endovascular thrombectomy (EVT). Observational studies have found associations between elevated BP after EVT with hemorrhagic transformation and poor functional outcome. However, blood pressure course after EVT has not been well characterized and optimal hemodynamic management in the immediate post-stroke period remains unresolved. We utilized blood pressure data up to 72 hours after EVT to identify distinct systolic BP (SBP) trajectories and studied their associations with functional outcome. Methods: We retrospectively studied a multicenter cohort of 1060 patients with large-vessel occlusion stroke who underwent EVT. BP was recorded non-invasively recorded at least hourly for the first 72 hours. Functional outcome was assessed using the modified Rankin scale (mRS). Favorable functional outcome was defined as mRS <. Latent variable mixture modeling was applied to identify patient subgroups that have comparable SBP trajectories. All analyses were adjusted for age, admission NIHSS, and recanalization status. Results: One thousand sixty patients (mean age 70±15, mean NIHSS 16) were included in the analysis. Five distinct SBP trajectories were identified: (1) low (17%), (2) moderate (38%), (3) moderate-to-high (21%), (4) high-to-moderate (17%), and (5) high (7%) (Figure 1A). SBP trajectory group was an independent predictor of functional outcome at discharge (p=0.001) and 90 days (p=0.010, Figure 1B). Patients with high and high-to-moderate SBP trajectories had a significantly higher odds of an unfavorable outcome at 90 days (adjusted OR 2.3, 95%CI 1.2 - 4.3, p=0.01 and adjusted OR 4, 95% CI 1.5-10.7, p=0.06, respectively) Conclusions: During the first 72 hours after EVT, acute ischemic stroke patients show distinct SBP trajectories, which differ in relation to functional outcome. The findings may help recognize potential candidates for future blood pressure control trials.
Source: Stroke
Authors: Sreeja Kodali, Can Meng, Sumita Strander, Cindy Khanh Nguyen, Andrew Silverman, Alexandra Kimmel, Krithika Umesh Peshwe, Anson Wang, Mohammad Anadani, Alejandro M Spiotta, Adam de Havenon, Ka-Ho Wong, Andrea Holcombe, Santiago Ortega-Gutiérrez, Cynthia Zevallos, Eva A Mistry, Hiba Fakhri, Akshitkumar Mistry, Karan Tarasaria, Amre Nouh, Ilko L Maier, Marios-Nikos Psychogios, Jan Liman, Nitin Goyal, Adam S Arthur, Abhi Pandhi, Stacey Q Wolfe, Fábio A Nascimento, Peter Kan, Nolwenn Riou-Comte, Benjamin Gory, Joon-Tae Kim, Kevin N Sheth, Nils Petersen
Institutions: Yale University, Washington University in St. Louis, Medical University of South Carolina, University of Utah, University of Iowa, Vanderbilt University Medical Center, University of Connecticut, Hartford Hospital, Universitätsmedizin Göttingen, University of Göttingen, University Hospital of Basel, Wake Forest University, Baylor College of Medicine, Université de Lyon, Chonnam National University, Chonnam National University Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3006301079