Abstract
Objective: The objective of this study was to evaluate the effect of blood pressure (BP) management with transcranial Doppler (TCD) guidance in patients with large-vessel occlusion in the anterior circulation after endovascular thrombectomy (EVT) on the long-term prognosis.Methods: This was a prospective study; 232 patients were nonrandomized assigned to TCD-guided BP management (TBM) group or non-TCD-guided BP management (NBM) group. In the TBM group, BP was controlled according to TCD showing cerebral blood flow fluctuation. In the NBM group, BP was controlled according to the guidelines. The primary endpoint was a modified Rankin scale (mRS) score of 2 or lower at 90 days. The safety outcomes were the rates of symptomatic or any intracerebral hemorrhage (ICH) and mortality at 90 days.Results: One hundred sixty-three patients were assigned to the TBM group, and 69 were assigned to the NBM group. In the propensity score-matched cohort (65 matches in both groups), there was significant difference in the proportion of participants with mRS 0–2 at 90 days according to BP management (adjusted odds ratio 3.34, 95% CI 1.36 to 8.22). There was no difference in the rates of symptomatic or any ICH and mortality between two groups. In inverse probability-weighted regression adjustment analysis, mortality decreased significantly in the TBM group than in the NBM group (adjusted odds ratio 0.86, 95% CI 0.76–0.99, p = 0.03).Conclusion: In patients with acute ischemic stroke from large-vessel occlusion in the anterior circulation, BP management under TCD was superior to NBM in improving the clinical outcomes at 90 days.Clinical Trial Registration: (URL: https://www.chictr.org.cn/showproj.aspx?proj=55484; Identifier: ChiCTR2000034443.
Highlights
Endovascular treatment (EVT) is the most effective treatment for cerebral large-vessel occlusion (LVO) of anterior circulation [1,2,3,4,5],
Studies of the association between postoperative blood pressure (BP) and clinical outcomes suggested that postoperative BP management is interacted with recanalization status in which successful recanalization needs lower BP to decrease the risk of brain edema and intracranial hemorrhage (ICH), while non-recanalization needs higher BP to sustain collateral perfusion and decrease final infarction volume
In patients with acute ischemic stroke due to LVO who were eligible for treatment with EVT, transcranial Doppler (TCD)-guided BP management during the post-procedural 24-h period was associated with better functional outcomes at 3 months
Summary
Endovascular treatment (EVT) is the most effective treatment for cerebral large-vessel occlusion (LVO) of anterior circulation [1,2,3,4,5],
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