Abstract TP42: Association of 24-Hour Blood Pressure Parameters Post-Thrombectomy With Functional Outcomes at Discharge

Abstract

Introduction: Elevation of blood pressure (BP) post mechanical thrombectomy (MT) can theoretically restore cerebral perfusion to the ischemic brain tissue, but it comes at a risk of causing reperfusion injury. The ideal BP in the 24-hour range after MT has been understudied. We investigated the association of different BP parameters post-MT with the functional outcome at discharge at a tertiary care center. Methods: We performed a retrospective chart review of adult patients who underwent MT for an anterior circulation large vessel occlusion at a comprehensive stroke center from July 2014 to March 2018. We recorded the BP values over a period of 24-hours post-MT. A binary logistic regression analysis was performed, controlling for age, pre-thrombectomy NIHSS-scores, thrombolysis in cerebral infarction (TICI)-scores, duration to thrombectomy, with the BP parameters as the predictors. The primary outcome was the functional outcome at discharge. Good outcome was defined as a modified rankin scale (mRS) of 0-2 and a poor outcome as mRS of 3-6, upon discharge. Results: 69 patients met our inclusion criteria. 39 (56.52%) patients were male. The mean age was 64.80±14 years. The mean pre-treatment NIHSS was 16.18±5. 22 (31.88%) patients had a good outcome (mRS≤2) at discharge. In the logistic regression model, the parameters of higher mean arterial pressure (MAP) variability like coefficient variation (CV) MAP (7.04±6 vs.3.13±5.; OR, 1.13; 95% CI,1.01-1.27; P 0.038) and standard deviation (SD) MAP (6.4±6 vs.2.75±4; OR, 1.15; 95% CI,1.02-1.31; P 0.032) were significantly associated with a poor outcome at discharge. The parameters of average systolic BP, average diastolic BP, and average MAP over 24-hours post-MT were not significantly associated with poor outcomes at discharge. Conclusions: Our study demonstrates a significant association between 24-hours-post-MT parameters of higher MAP variability like CV MAP and SD MAP and poor functional outcomes at discharge.